Genicular Nerve Injection

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Genicular Nerve Injection
Indication	Knee Osteoarthritis
Syringe	?
Needle	?
Steroid	20mg triamcinolone optional
Local	6mL
Volume	6mL + steroid

Background

A genicular nerve injection can be used to treat knee osteoarthritis pain with or without steroid. The addition of steroid provides a longer effect but this wanes between 4-8 weeks. With lidocaine alone the effect wanes by 2-4 weeks. However clinically significant relief is only maintained for two weeks. Clinical improvements in functional capacity persist for one week in both options. The use of corticosteroid to enhance a peripheral nerve block remains controversial.

Technique

Ultrasound Guided

• Position: Supine with pillow under the knee.
• The genicular nerves (superior lateral, superior medial, and inferior medial) run next to the genicular arteries next to the periosteum of the distal femoral condyle and medial tibial metaphysis.
• The nerves may be unidentifiable which does not make the procedure contraindicated
• confirm vessel location using colour doppler.
• Deposit 2mL next to each genicular artery, for a total of 6mL, plus steroid if using.