Background & Aims

Knee osteoarthritis (OA) is a chronic degenerative disease associated with severe knee pain, functional limitation, and decreased quality of life1. The sensory innervation of knee joints consists of genicular branches from the femoral, tibial, and common peroneal, obturator and saphenous nerves2. Ultrasound guided genicular nerve block particularly superomedial, superolateral and inferomedial genicular nerves with local anaesthetic and corticosteroids is a minimally invasive treatment method available for knee OA pain3.However, there is limited information on factors affecting long term efficacy of genicular nerve block. So, the present study aims to explore the factors affecting the efficacy of genicular nerve block for the treatment of knee joint osteoarthritis pain.

Methods

This study is a retrospective observation study on patients undergoing knee genicular block for knee joint osteoarthritis pain in Pain Clinic, Department of Anaesthesiology from January 2012 to December 2022. The patients who underwent ultrasound guided superomedial, superolateral and inferomedial genicular nerve block with bupivacaine 0.25% with 1 mg dexamethasone at each site included in the study whereas the patients with incomplete outcome data at 24 months were excluded. The medical records of these patients were reviewed for age, gender, body mass index (BMI), Kellgren-Lawrence grading, toilet type (Indian or western) and physical therapy. The Numerical rating scores (NRS)(0-100) were also reviewed at 1 week, 1 month, 2 months, 12 months, and 24 months. The patients were grouped into either respondents (NRS <50) or non-respondents (NRS?50).

Results

A total of 217 patients (110 males, 107 female) who underwent genicular nerve block were included in the study. The mean pre-procedure NRS of patients was 68.84, while post procedure it reduced to 19.44 at 1 week, 23.61 at 1 month, 30.69 at 2 months, 39.67 at 6 months, 45.96 at 12 months and 56.54 at 24 months. At 12 months univariate logistic regression analysis for patients with NRS ?50 as non-respondents and NRS <50 as respondents suggests that age (OR, 0.925; 95% CI, 0.863 –0.991; P = 0.027), BMI (OR, 0.152; 95% CI, 0.04-0.578; P = 0.006) and exercises (OR, 1.994; 95% CI, 1.048–3.795; P = 0.035) are the factors affecting efficacy of genicular nerve block. While at 24 months, univariate logistic regression analysis showed BMI (OR, 0.126; 95% CI, 0.025–0.628; P = 0.012), use of western toilet (OR, 4.613; 95% CI, 2.451–8.684; P = <0.001) and exercises (OR, 3.656; 95% CI, 2.063–6.48; P = <0.001) are the main predicting factors affecting the efficacy of genicular nerve block.

Conclusions

USG guided genicular nerve block is an effective minimally invasive treatment modality for knee osteoarthritis pain with age, BMI, type of toilet and exercises affecting its long-term efficacy.

References

1.Araujo ILA, Castro MC, Daltro C, Matos MA. Quality of life and functional independence in patients with osteoarthritis of the knee. Knee Surg. Relat. Res. 28(3), 219–224 (2016).
2.Hirasawa Y, Okajima S, Ohta M, Tokioka T. Nerve distribution to the human knee joint: anatomical and immune-histochemical study. Int Orthop. 2000; 24 [1]:1-4. [DOI: 10.1007/s002640050001]
3.Tan YL, Neo EJR, Wee TC. Ultrasound-guided Genicular Nerve Blockade With Pharmacological Agents for Chronic Knee Osteoarthritis: A Systematic Review. Pain Physician. 2022 Jul;25(4):E489-E502. PMID: 35793174.
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Presenting Author

Sandeep

Poster Authors

Sandeep Khuba

MD, PDCC

Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow

Lead Author

E-mail

sanjay kumar

Sanjay Gandhi Postgraduate Institute of Medical sciences, Lucknow

Lead Author

E-mail

Sujeet Kumar Singh Gautam

Sanjay Gandhi Postgraduate Institute of Medical sciences, Lucknow

Lead Author

E-mail

Topics

  • Models: Musculoskeletal