Download PDF
CC BY 4.0 · Rev Bras Ortop (Sao Paulo) 2024; 59(06): e876-e882
DOI: 10.1055/s-0044-1793825
Artigo Original
Joelho

Efficacy of Genicular Nerve Block in Patients with Osteoarthritis: A Comparative Study with and without Fluoroscopy Assistance

Article in several languages: português | English
Nour Aliman El Majzoub Said 
1   Grupo do Joelho e Artroscopia, Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil
,
Alexandre Barbieri Mestriner 
1   Grupo do Joelho e Artroscopia, Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil
,
Heloisa Sungaila 
1   Grupo do Joelho e Artroscopia, Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil
,
Enzo Salviato Mameri 
1   Grupo do Joelho e Artroscopia, Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil
,
Carlos Eduardo Silveira Franciozi 
1   Grupo do Joelho e Artroscopia, Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil
,
Marcelo Seiji Kubota 
1   Grupo do Joelho e Artroscopia, Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil
› Author Affiliations Financial Support The authors declare that they did not receive financial support from agencies in the public, private, or non-profit sectors to conduct the present study.
› Further Information
Also available at
   Permissions and Reprints

Abstract

Objective To compare the efficacy of fluoroscopy as an auxiliary method in genicular nerve block (GNB) with block guidance by anatomical parameters, without imaging aid, in reducing pain.

Methods A total of 23 patients underwent fluoroscopy-guided or anatomical parameter-based GNBs. We applied the Western Ontario and McMaster Universities' Osteoarthritis Index (WOMAC) and the Visual Analog Scale (VAS) for pain at 6 time points (preblock, and after 1 hour, 24 hours, 7 days, 28 days, and 90 days).

Results The mean age of the sample was of 64.5 ± 4.8 years, and the mean Body Mass Index (BMI), of 31.4 ± 6.1 Kg/m2; 16 subjects (69.6%) were women. The WOMAC pain subscale showed a significant reduction (p < 0.05) in pain in both groups at all time points. This reduction was greater after 1 hour in both groups, with rates if 64.3% and 64.6% in the fluoroscopy and anatomical parameters groups respectively, with no significant difference. At the end of 90 days, the pain reduction rates were of 35.7% and 44.6% in the fluoroscopy and anatomical parameter groups respectively. The VAS also showed a significant reduction (p < 0.05) in pain in both groups at all times. The reduction was more significant after 1 hour: 78.0% in the fluoroscopy group and 82.2% in the anatomical parameter group, with no significant difference. At the end of 90 days, the pain reduction was of in the fluoroscopy group 36.5% and of 24.6% in the anatomical parameters group.

Conclusion The GNBs guided by fluoroscopy or by anatomical parameters alone were equally effective in terms of magnitude and duration of pain relief.

Keywords

fluoroscopy - nerve block - osteoarthritis, knee - pain - visual analog pain scale

Work carried out at the Knee and Arthroscopy Group, Department of Orthopedics and Traumatology, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.




Publication History

Received: 14 June 2023

Accepted: 14 November 2023

Article published online:
21 December 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 

  • Referências

  • 1 Cross M, Smith E, Hoy D. et al. The global burden of hip and knee osteoarthritis: estimates from the global burden of disease 2010 study. Ann Rheum Dis 2014; 73 (07) 1323-1330
    CrossrefPubMedSearch in Google Scholar
  • 2 Sharif B, Kopec J, Bansback N. et al. Projecting the direct cost burden of osteoarthritis in Canada using a microsimulation model. Osteoarthritis Cartilage 2015; 23 (10) 1654-1663
    CrossrefPubMedSearch in Google Scholar
  • 3 Losina E, Walensky RP, Kessler CL. et al. Cost-effectiveness of total knee arthroplasty in the United States: patient risk and hospital volume. Arch Intern Med 2009; 169 (12) 1113-1121 , discussion 1121–1122
    CrossrefPubMedSearch in Google Scholar
  • 4 Pereira D, Peleteiro B, Araújo J, Branco J, Santos RA, Ramos E. The effect of osteoarthritis definition on prevalence and incidence estimates: a systematic review. Osteoarthritis Cartilage 2011; 19 (11) 1270-1285
    CrossrefPubMedSearch in Google Scholar
  • 5 GBD 2015 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet 2016; 388 (10053): 1545-1602
    CrossrefPubMedSearch in Google Scholar
  • 6 Ergönenç T, Beyaz SG. Long-term effects of ultrasound-guided genicular nerve pulsed radiofrequency on pain and knee functions in patients with gonarthrosis. Sakarya Med J 2019; 9 (01) 52-58
    Search in Google Scholar
  • 7 Hunter DJ, Bierma-Zeinstra S. Osteoarthritis. Lancet 2019; 393 (10182): 1745-1759
    CrossrefPubMedSearch in Google Scholar
  • 8 Crawford DC, Miller LE, Block JE. Conservative management of symptomatic knee osteoarthritis: a flawed strategy?. Orthop Rev (Pavia) 2013; 5 (01) e2
    PubMedSearch in Google Scholar
  • 9 Choi WJ, Hwang SJ, Song JG. et al. Radiofrequency treatment relieves chronic knee osteoarthritis pain: a double-blind randomized controlled trial. Pain 2011; 152 (03) 481-487
    CrossrefPubMedSearch in Google Scholar
  • 10 Kesikburun S, Yaşar E, Uran A, Adigüzel E, Yilmaz B. Ultrasound-guided genicular nerve pulsed radiofrequency treatment for painful knee osteoarthritis: a preliminary report. Pain Physician 2016; 19 (05) E751-E759
    CrossrefPubMedSearch in Google Scholar
  • 11 McCormick ZL, Korn M, Reddy R. et al. Cooled radiofrequency ablation of the genicular nerves for chronic pain due to knee osteoarthritis: six-month outcomes. Pain Med 2017; 18 (09) 1631-1641
    CrossrefPubMedSearch in Google Scholar
  • 12 Protzman NM, Gyi J, Malhotra AD, Kooch JE. Examining the feasibility of radiofrequency treatment for chronic knee pain after total knee arthroplasty. PM R 2014; 6 (04) 373-376
    CrossrefPubMedSearch in Google Scholar
  • 13 Sarı S, Aydın ON, Turan Y, Özlülerden P, Efe U, Kurt Ömürlü İ. Which one is more effective for the clinical treatment of chronic pain in knee osteoarthritis: radiofrequency neurotomy of the genicular nerves or intra-articular injection?. Int J Rheum Dis 2018; 21 (10) 1772-1778
    CrossrefPubMedSearch in Google Scholar
  • 14 Cankurtaran D, Karaahmet OZ, Yildiz SY, Eksioglu E, Dulgeroglu D, Unlu E. Comparing the effectiveness of ultrasound guided versus blind genicular nerve block on pain, muscle strength with isokinetic device, physical function and quality of life in chronic knee osteoarthritis: a prospective randomized controlled study. Korean J Pain 2020; 33 (03) 258-266
    CrossrefPubMedSearch in Google Scholar
  • 15 Yasar E, Kesikburun S, Kılıç C, Güzelküçük Ü, Yazar F, Tan AK. Accuracy of ultrasound-guided genicular nerve block: a cadaveric study. Pain Physician 2015; 18 (05) E899-E904
    PubMedSearch in Google Scholar
  • 16 Franco CD, Buvanendran A, Petersohn JD, Menzies RD, Menzies LP. Innervation of the anterior capsule of the human knee: implications for radiofrequency ablation. Reg Anesth Pain Med 2015; 40 (04) 363-368
    CrossrefPubMedSearch in Google Scholar
  • 17 Sutaria RG, Lee SW, Kim SY, Howe R, Downie SA. Localization of the lateral retinacular nerve for diagnostic and therapeutic nerve block for lateral knee pain: a cadaveric study. PM R 2017; 9 (02) 149-153
    CrossrefPubMedSearch in Google Scholar
  • 18 DemIr Y, Güzelküçük Ü, Tezel K, AydemIr K, Taşkaynatan MA. AydemIr K, Taskaynatan MA. A different approach to the management of osteoarthritis in the knee: ultrasound guided genicular nerve block. Pain Med 2017; 18 (01) 181-183
    CrossrefPubMedSearch in Google Scholar
  • 19 Kim DH, Lee MS, Lee S, Yoon SH, Shin JW, Choi SS. A prospective randomized comparison of the efficacy of ultrasound- vs fluoroscopy-guided genicular nerve block for chronic knee osteoarthritis. Pain Physician 2019; 22 (02) 139-146
    PubMedSearch in Google Scholar
  • 20 Fernandes MI. Tradução e validação do questionário de qualidade de vida específico para osteoartrose WOMAC (Western Ontario and McMaster Universities) para a língua portuguesa [tese]. São Paulo: Universidade Federal de São Paulo, Escola Paulista de Medicina; 2003
    Search in Google Scholar
  • 21 Martinez JE, Grassi DC, Marques LG. Análise da aplicabilidade de três instrumentos de avaliação de dor em distintas unidades de atendimento: ambulatório, enfermaria e urgência. Rev Bras Reumatol 2011; 51 (04) 304-308
    CrossrefSearch in Google Scholar