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. [1]

Anatomy

There are three main nerves that supply sensory input to the knee joint. The superior lateral, the superior medial, and the inferior medial genicular nerves.

Genicular.jpg

Indications

Contraindications

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.

Non-ultrasound Guided

Complications

Aftercare

Videos

See Also

External Links

References

  1. Kim DH, Choi SS, Yoon SH, et al. Ultrasound-Guided Genicular Nerve Block for Knee Osteoarthritis: A Double-Blind, Randomized Controlled Trial of Local Anesthetic Alone or in Combination with Corticosteroid. Pain Physician. 2018;21(1):41-52.

Literature Review