Total Knee Arthroplasty After Genicular Nerve Radiofrequency Ablation: Reduction in Prolonged Opioid Use Without Increased Postsurgical Complications

Stake, Seth; Agarwal, Amil R.; Coombs, Stefan; Cohen, Jordan S.; Golladay, Gregory J.; Campbell, Joshua C.; Thakkar, Savyasachi C.

doi:10.5435/jaaosglobal-d-22-00125

Cited by 5 publications

(18 citation statements)

References 35 publications

(46 reference statements)

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“…Type of GNRFA differed between the studies included in this analysis. Within the pre-TKA group, two studies performed cooled ablation, where temperatures were dropped to −87 °C at the needle tips [ 24 , 27 ] while the rest performed thermal nerve ablation, where temperatures ranged between 77 °C and 80 °C [ 20 , 21 , 23 ]. Among the painful-TKA group, two studies similarly performed thermal GNRFA [ 22 , 25 ] while one study performed pulsed radiofrequency ablation with a temperature set to 42 °C [ 26 ].…”

Section: Resultsmentioning

confidence: 99%

“…Among the pre-TKA articles, three studies noted no difference in outcome measures between GNRFA and control groups [ 20 , 21 , 23 ] (Table 2 ). Walega et al.…”

Section: Resultsmentioning

confidence: 99%

“…In addition, Stake et al. found that there were lower rates of surgery-associated complications, including postoperative anemia, atrial fibrillation, arrhythmia, blood transfusion requirement, and urinary tract infection among the GNRFA when compared with the non-GNRFA group [ 21 ]. While not an adverse event, Walega et al.…”

Section: Resultsmentioning

confidence: 99%

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Genicular nerve radiofrequency ablation: a systematic review of application for perioperative pain control in total knee arthroplasty and as treatment for chronic pain in well-appearing total knee arthroplasty

Nnake,

El-Othmani,

Cooper

et al. 2024

Knee Surg & Relat Res

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Background Total knee arthroplasty (TKA) is a successful treatment for end-stage osteoarthritis, yet some patients still experience postoperative pain. Genicular nerve radiofrequency ablation (GNRFA) has become a potential modality to address pain in TKA. This systematic review aims to critically analyze the applicability of GNRFA in perioperative pain control prior to TKA, as well as a treatment modality for chronic painful well-appearing TKA. Methods PubMed, Medline, EMBASE, Google Scholar, Scopus, and COCHRANE databases, as well as the ClinicalTrials.gov register, were reviewed. The search included randomized controlled trials and cohort studies. The sample population focused on two cohorts; those who underwent TKA and utilized intentional GNRFA as a perioperative pain control modality, and those utilizing the treatment modality for chronic pain in well-appearing TKA. GNRFA was the intervention studied, and postoperative outcomes were compared with the control group, which consisted of those not receiving GNRFA. Result Eight total publications were identified as relevant to this search. Among the pre-TKA studies, there was variability in results; these inconsistencies were attributed to a lack of standardization, especially with regard to type, timing, and targeted nerves with ablation. Likewise, while the results were improved among the population with chronic painful TKA receiving GNRFA, these inconsistencies still existed. Conclusions Current evidence suggests GNRFA as a possible pre-TKA intervention to potentially minimize opioid consumption, patient-reported pain, length of stay, and increased range of motion and activity. However, the short-lived duration in the setting of chronically painful well-appearing TKA represents a major barrier that warrants further investigation. Limitations include small sample size, heterogeneity, lack of standardization of techniques among studies, and lack of direct comparison and meta-analysis. Further research should focus on the standardization of technique as well as analyzing various patient and health-system-related factors that correlate with sustained positive outcomes.

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Section: Resultsmentioning

confidence: 99%

“…Among the pre-TKA articles, three studies noted no difference in outcome measures between GNRFA and control groups [ 20 , 21 , 23 ] (Table 2 ). Walega et al.…”

Section: Resultsmentioning

confidence: 99%

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Genicular nerve radiofrequency ablation: a systematic review of application for perioperative pain control in total knee arthroplasty and as treatment for chronic pain in well-appearing total knee arthroplasty

Nnake,

El-Othmani,

Cooper

et al. 2024

Knee Surg & Relat Res

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“…In addition to transitional pain services, the use of interventional pain management has demonstrated a reduction in postoperative opioid use after joint replacement surgery with the use of genicular nerve radiofrequency ablations prior to knee replacement [34]. The reduction of postoperative opioid use in knee replacement surgery with the use of preoperative interventional pain techniques warrants further investigation for other types of surgeries.…”

Section: Transitional Pain Servicesmentioning

confidence: 99%

Perioperative pain optimization in the age of the opioid epidemic

Patel,

Snyder,

Brooks

2024

Current Opinion in Anaesthesiology

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Purpose of review The opioid epidemic remains a constant and increasing threat to our society with overdoses and overdose deaths rising significantly during the COVID-19 pandemic. Growing evidence suggests a link between perioperative opioid use, postoperative opioid prescribing, and the development of opioid use disorder (OUD). As a result, strategies to better optimize pain management during the perioperative period are urgently needed. The purpose of this review is to summarize the most recent multimodal analgesia (MMA) recommendations, summarize evidence for efficacy surrounding the increased utilization of Enhanced Recovery After Surgery (ERAS) protocols, and discuss the implications for rising use of buprenorphine for OUD patients who present for surgery. In addition, this review will explore opportunities to expand our treatment of complex patients via transitional pain services. Recent findings There is ample evidence to support the benefits of MMA. However, optimal drug combinations remain understudied, presenting a target area for future research. ERAS protocols provide a more systematic and targeted approach for implementing MMA. ERAS protocols also allow for a more comprehensive approach to perioperative pain management by necessitating the involvement of surgical specialists. Increasingly, OUD patients taking buprenorphine are presenting for surgery. Recent guidance from a multisociety OUD working group recommends that buprenorphine not be routinely discontinued or tapered perioperatively. Lastly, there is emerging evidence to justify the use of transitional pain services for more comprehensive treatment of complex patients, like those with chronic pain, preoperative opioid tolerance, or substance use disorder. Summary Perioperative physicians must be aware of the impact of the opioid epidemic and explore methods like MMA techniques, ERAS protocols, and transitional pain services to improve the perioperative pain experience and decrease the risks of opioid-related harm.

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“…Stake et al compared 2-year postoperative complication rates and rates of prolonged postoperative opioid usage between individuals undergoing TKA after previous genicular nerve RF and those undergoing TKA alone. Individuals who underwent primary TKA after prior genicular nerve RF (RF-TKA) of the ipsilateral knee were identified in national all-payer claims (60). In total, 675 individuals in the genicular nerve RF-TKA group were compared with a control group of 255 351 individuals.…”

Section: Rf In Tkamentioning

confidence: 99%

Upper limb and lower limb radiofrequency treatments in orthopaedics

2023

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Radiofrequency (RF) is a minimally invasive technique for disrupting or altering nociceptive pathways to treat musculoskeletal neuropathic and nociplastic pain. RF has been employed to treat painful shoulder, lateral epicondylitis, knee and hip osteoarthritis, chronic knee pain, Perthes disease, greater trochanteric pain syndrome, plantar fasciitis, and painful stump neuromas; it has also been employed before and after painful total knee arthroplasty and after anterior cruciate ligament reconstruction. The benefits of RF include the following:it is safer than surgery; there is no need for general anaesthesia, thereby reducing adverse effects; it alleviates pain for a minimum of 3–4 months; it can be repeatable if necessary; and it improves joint function and minimizes the need for oral pain medication. RF is contraindicated for pregnant women; unstable joints (hip, knee, and shoulder); uncontrolled diabetes mellitus; presence of an implanted defibrillator; and chronic joint infection (hip, knee, and shoulder). Although adverse events from RF are unusual, potential complications can include infection, bleeding, numbness or dysesthesia, increased pain at the procedural site, deafferentation effect, and Charcot joint neuropathy. Although there is a risk of damaging non-targeted neural tissue and other structures, this can be mitigated by performing the technique under imaging guidance (fluoroscopy, ultrasonography, and computed tomography). RF appears to be a valuable technique for alleviating chronic pain syndromes; however, firm proof of the technique’s efficacy is still required. RF is a promising technique for managing chronic musculoskeletal of the limbs pain, particularly when other techniques are futile or not possible.

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Total Knee Arthroplasty After Genicular Nerve Radiofrequency Ablation: Reduction in Prolonged Opioid Use Without Increased Postsurgical Complications

Cited by 5 publications

References 35 publications

Genicular nerve radiofrequency ablation: a systematic review of application for perioperative pain control in total knee arthroplasty and as treatment for chronic pain in well-appearing total knee arthroplasty

Genicular nerve radiofrequency ablation: a systematic review of application for perioperative pain control in total knee arthroplasty and as treatment for chronic pain in well-appearing total knee arthroplasty

Perioperative pain optimization in the age of the opioid epidemic

Upper limb and lower limb radiofrequency treatments in orthopaedics

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