Genicular Nerve Injection
|Genicular Nerve Injection|
|Steroid||20mg triamcinolone optional|
|Volume||6mL + steroid|
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. 
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.
- 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.
- 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.
- Reviews from the last 7 years: review articles, free review articles, systematic reviews, meta-analyses, NCBI Bookshelf
- Articles from all years: PubMed search, Google Scholar search.
- TRIP Database: clinical publications about evidence-based medicine.
- Other Wikis: Radiopaedia, Wikipedia Search, Wikipedia I Feel Lucky, Orthobullets,