ULTRASOUND-GUIDED GENICULAR NERVE BLOCK WITH LOCAL ANAESTHETIC AND CORTICOSTEROID FOR PAIN RELIEF IN KNEE OSTEOARTHRITIS AT A TERTIARY CARE HOSPITAL IN KASHMIR VALLEY.

Main Article Content

Dr. Abdul Hakeem
Dr. Syed Faisal Andrabi
Dr. Sadia Lanker

Keywords

Chronic pain, knee osteoarthritis, genicular nerve block, ultrasound, corticosteroid, local anesthetic, Oxford Knee Score

Abstract

Background: Chronic knee osteoarthritis (OA) is a frequent disease among the elderly. Intra-articular corticosteroid injection (IACSI) was commonly adopted to alleviate knee OA-related pains. Recently, Genicular nerve block (GNB) has emerged as a new alternative technique. Diagnostic genicular nerve block (GNB) with local anesthetic has been generally conducted before making decisions regarding RF ablation. Although GNB has been recently performed together with corticosteroid, the analgesic effects of corticosteroids for treating chronic pain remain controversial.  Aim: To assess the effects of corticosteroids and local anesthesia during ultrasound-guided GNB in patients with chronic knee OA. 


Methods: A profile of 30 Patients of knee osteoarthritis of moderate or higher grade, not responding to conservative treatment of physiotherapy and anti inflammatory drugs, were enrolled for the study. Patients having blood coagulopathies, unfit medical conditions, and local and systemic infections, Kellgren-Lawrence (KL) grade I were excluded.


Results: 15 patients (50%) had KL classification grade II knee osteoarthritis, while 11 patients (36.6%) had KL grade III and 4 patients (13.3%) had KL grade IV knee osteoarthritis among the study population. Mean OKS scores before treatment to OKS score at 24 hours showed very highly significant difference (p=0.0000) while scores remained similar at 4 and 12 weeks.


Conclusion: Ultrasound guided genicular nerve block using corticosteroid injection for knee osteoarthritis seems to be effective in decreasing pain and improving functional outcome in patients with severe osteoarthritis. However, further studies with larger sample size and longer duration of follow up are required to draw robust conclusions.

Abstract 98 | Pdf Downloads 39

References

1. Dutta D, Baral BK, Amatya M. Ultrasound-Guided Genicular Nerve Block using Corticosteroid injection for Knee Osteoarthritis at a Tertiary Care Hospital in Kathmandu, Nepal. PMJN July-Dec 19(2):43-46.
2. Felson DT, Zhang Y. An update on the epidemiology of knee and hip osteoarthritis with a view to prevention. Arthritis Rheum 41: 1343-1355.
3. Hinman RS, Bowles KA, Bennell KL. Laterally wedged insoles in knee osteoarthritis: do biomechanical effects decline after one month of wear? BMC MusculoskeletDisord 10: 146.
4. Pal CP, Singh P, Chaturvedi S, Pruthi KK, Vij A. Epidemiology of knee osteoarthritis in India and related factors. Indian J Orthop. 2016 Sep;50(5):518-522.
5. Rathore R, Joshi M, Saharan A, Agrawal H. Effect of ultrasound guided genicular nerve block in knee osteoarthritis with neuropathic pain. Indian J Phy Med Rehab 2022;32:72-8.
6. Luyten F, Dell’accio F, De Bari C. Skeletal Tissue Engineering: Opportunities and Challenges. Best Pract Res ClinRheumatol. (2008); 15: 7 59-69.
7. Flanigan DC, Harris JD, Trinh TQ, Siston RA, Brophy RH, et al. Prevalence of Chondral Defects in Athlete’s Knees A Systematic Review. Med Sci Sports Exerc. 2010; 42: 795-801.Snibbe JC, Gambardella RA. Use of injections for osteoarthritis in joints and sports activity. Clin Sports Med. 2005;24(1):83–91.
8. Kim DH, Soo Choi S,Yoon S 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: 41-51
9. De Oliveira GS Jr., Castro Alves LJ, Nader A, Kendall MC, Rahangdale R, McCarthy RJ. Perineural dexamethasone to improve postoperative analgesia with peripheral nerve blocks: A meta analysis of randomized controlled trials. Pain Res Treat 2014;2014:179029.
10. Afridi SK, Shields KG, Bhola R, Goadsby PJ. Greater occipital nerve injection in primary headache syndromes prolonged effects from a single injection. Pain 2006;122:126 9.
11. Qudsi Sinclair S, Borrás Rubio E, Abellan Guillén JF, Padilla Del Rey ML, Ruiz Merino G. A comparison of genicular nerve treatment using either radiofrequency or analgesic block with corticosteroid for pain after a total knee arthroplasty: A double blind, randomized clinical study. Pain Pract 2017;17:578 88.