Genicular Nerve Block
Chronic osteoarthritis pain of the knee is not managed efficiently with prescribed medications. Although surgery is an effective method for patients with advanced conditions, some particular patients with chronic conditions may not be appropriate for surgical procedures. Radiofrequency ablation of the Genicular nerves can be the best alternative for such patients. Genicular nerve is the nerves that provide pain and sensation to the knee joint. Typically, there are three sections aimed at genicular nerve block– the superior lateral, the superior medial, and the interior medial genicular nerves.
Genicular nerve block
Patients with chronic knee pain that has not responded to the conservative care may be referred to undergo genicular nerve block. The process is based on the theory that cutting the nerve supply to a painful structure may relieve the pain and restore its function.
The procedure is done under the x-ray guidance. In case you are a female; you are advised to ensure there is no chance of you getting pregnant on the day of the procedure.
The conditions that are mainly treated with genicular nerve block include:
- severe knee pain
- severe osteoarthritis
- Patients who want to avoid a knee replacement
- chronic knee pain
- Patients unfit for knee replacement
- Deteriorating joint illness of the knees
- Partial Knee Replacement (before or after)
- Total Knee Replacement (before or after)
The procedure/what to expect
The procedure applies a breakthrough innovation technique that is called Radiofrequency ablation to shock the nerves in pain and prevent the signals from reaching the brain. The technology has been used for several years yielding good reviews. The Radiofrequency ablation makes use of the radio signals to treat pain at the source not relying on any opening. This procedure is important for patients who have undergone the pain relief that result from diagnostic block procedure. During the RFA, fluoroscopic descriptions of the anteroposterior and adjacent result of the knee are reflected on a screen to help the doctors accurately locate and treat the affected areas. A local anesthetic will be administered to ensure comfortability of the patients throughout the entire procedure. After making an incision in the knee region, a radiofrequency electrode tip will be inserted into the periosteal regions which provide a link between the shaft the femur and shaft of the tibia. The small generator helps the radiofrequency waves to be created and introduced to the peak of the needle where a heat lesion is then created. This heat lesion will be placed on the superior lateral, superior medial, and inferior medial genicular nerves which then effectively stops the abnormal pain signals to the central nervous system. Once all of the affected nerves have been treated, the needle will be removed and the incision closed. A positive response is tallied if there is a 50% reduction in pain within the first 24 hours of administering the procedure.
After the procedure, you will be sent to a recovery room which will take some time before the sedative wears off. Driving is prohibited after the process and all the appropriate transportation means need to be planned by the patient. Normal activities can begin a day after the procedure unless you are given an exception by the doctor. A follow-up evaluation is made to monitor the progress of the patient and realizes the effectiveness of the procedure. If you are under a water tablet, please ensure that you take an extra water tablet the next day. In case you have diabetes, makes sure to monitor your blood sugar every day for two weeks after the procedure.
Benefits of Genicular Nerve Block for Pain Management
- Minimally invasive, nonsurgical treatment option to relieve pain when other more conventional therapies have failed.
- The procedure is conducted outside of the knee capsule which minimizes the risk of infection.
- Inexpensive and covered by most insurances
- It does not need an injection of steroids or hyaluronic acid or other medication
- In-office procedure
- The benefit of RFA is that it can be used on patients with diabetes and high blood pressure because they do not use cortisone injections or steroids.
- Requires only local anesthetic unlike general or regional anesthesia required for surgery
- No need for blood thinners unlike the four weeks of blood thinners (anticoagulation) required after knee replacement
- The time for recovery is minimal
- May return to work and normal activities within a few days if not the same day
- Little to no postoperative pain
How does it work
The procedure makes use of a technology referred to as Radiofrequency Ablation to cut the nerves preventing the signals from, getting to the brain. The significance of the procedure is that the nerve gets to grow back making it reversible. It uses the radio waves to treat pain from the source.
How many treatments do I need?
Before scheduling for a genicular neutromy, your Board Certified Pain Specialist will perform a genicular nerve block to ensure that you are the best patients for an ablation process. The effects of pain-relieving will take up to a year or longer.
The procedure is carried out in two phases under fluoroscopic guidance.
Diagnostic Genicular nerve block
This phase of the procedure involves placing small amount of anaesthetic on the genicular nerves to see the response of the patients and to see if there is a sufficient relief in the knee area to get a reason to undertake therapeutic neurotomy. In case the patients have painful joints, a light anesthetic can be administered to them to ensure they are comfortable. You will be instructed to lie on your back, and the area around your knee sterilized thoroughly to reduce any cases of infection. The specific areas where the genicular nerves are thought to be presented are illuminated using fluoroscopy and labelled on the skin. The region will be made numb to ensure maximum comfort. Three thin needles are inserted, and a dye is put to ensure they are in the appropriate spots. A small dose of anesthetic is applied.
Genicular nerve ablation.
In this phase, the doctor performs the Radiofrequency ablation RFA on the genicular nerves reducing the pain and restoring the functions of the knee. These stages face the diagnostic portion has been completed. This procedure puts into consideration that one can reduce pain and reinstate function by cutting the nerve supply. Patients with a positive response are offered the radiofrequency ablation for a more sustained response.
When will I feel better
The relief of this procedure can take effect after 4 to 6 weeks after the completion of the process. You will have some pain and swelling after the procedure, but you will have less pain in the knee area. The nerve block effects can persist for a few days. It is advisable for the patients to have an enough rest in the day and resume their daily activities as soon as they feel the pain and swelling have subsided. You will realize that after the pain has subsided and the swelling has reduced, you will be under less medication and can do most activities as usual. In this state, the nerve block is regarded as successful. In this state, the physician will schedule you for a nerve deadening. The procedure is similar but it involves the doctor will perform the neurotomy process by using special needles. The pain relief will last for a period between 6 months and 2 years.
Is this procedure right for me? What are the risks/benefits?
The procedure is minimal and less scary, and hence it can be performed on anyone, and a can be a substitute for patients who do not want to undergo surgery. It can also be performed on patients who have pain after surgical operations. The complication cases for this procedure are quite rare. Some serious cases that occur in a rare case are death and paralysis. Allergy is common reactions caused by the use of the medication. And therefore the patients are advised to communicate to their doctors in case they have an allergic reaction to any of the local anesthetic used during the procedure.
Some of the side effects that you may experience within the short few hours of the procedure are:
- Dizziness which is caused by the decrease in the blood pressure. In case of this feeling, you are advised to sit or lie back and gradually stand after about 10 minutes.
- Leg muscles or numbness may occur due to the local anesthetics applied to the nerve of the leg. This feeling should not be confused with paralysis as it is a healthy feeling. In this case, walk with help to minimize the injury that may result due to a fall. You will have the strength of your legs slowly.
- You may experience mild headaches. Take pain medications and lots of fluids. In case it persists, consults your physician.
- Some discomfort at the injection area. This will last for a few hours to a couple of days. In case it occurs, you are advised to take pain relievers or anti-inflammatories. You can apply ice on the area after the procedure.
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