Korean J Pain.  2019 Jul;32(3):223-227. 10.3344/kjp.2019.32.3.223.

Alcohol neurolysis of genicular nerve for chronic knee pain

• Dass RM
• Kim E
• Kim HK
• Lee JY
• Lee HJ
• Rhee SJ

• KMID: 2455618
• DOI: http://doi.org/10.3344/kjp.2019.32.3.223

Abstract

Radiofrequency neurolysis (RFN) of the genicular nerves has recently become accepted as an effective technique to alleviate knee pain particularly in patients with knee osteoarthritis (OA) or postoperative pain. However, genicular nerve RFN can produce high procedure and equipment costs, longer procedural times, procedure-related pain, and failure rate of over 25%. We are presenting two cases of alcohol neurolysis of the genicular nerve using fluoroscopy and ultrasonography in patients with knee OA or persistent postsurgical pain of the knee. Alcohol neurolysis of the genicular nerve with dual imaging modality can be a cheap, safe and effective method in patients with chronic knee pain.

Keyword

Ethanol; Fluoroscopy; Knee; Nerve Block; Osteoarthritis; Pain, Postoperative; Radiofrequency Therapy; Ultrasonography

MeSH Terms

Ethanol
Fluoroscopy
Humans
Knee*
Methods
Nerve Block
Osteoarthritis
Osteoarthritis, Knee
Pain, Postoperative
Ultrasonography
Ethanol

Figure

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  Fig. 1 Anteroposterior (A) and lateral (B) fluoroscopys view of contrast and lidocaine mixture spread. Ultrasound view (C) during injection of contrast and lidocaine mixture in superomedial genicular nerve.

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  Fig. 2 Knee Osteoarthritis and Outcome Score (KOOS) for case 1 (A). Note that significant improvement in symptoms, pain and quality of life. KOOS for case 2 (B). Note that significant improvement in all categories and total score. ADL: activities of daily living.

Reference

1. Mäntyselkä P, Kumpusalo E, Ahonen R, Kumpusalo A, Kauhanen J, Viinamäki H, et al. Pain as a reason to visit the doctor: a study in Finnish primary health care. Pain. 2001; 89:175–80. DOI: 10.1016/S0304-3959(00)00361-4. PMID: 11166473.

2. Wylde V, Hewlett S, Learmonth ID, Dieppe P. Persistent pain after joint replacement: prevalence, sensory qualities, and postoperative determinants. Pain. 2011; 152:566–72. DOI: 10.1016/j.pain.2010.11.023. PMID: 21239114.

3. Peat G, McCarney R, Croft P. Knee pain and osteoarthritis in older adults: a review of community burden and current use of primary health care. Ann Rheum Dis. 2001; 60:91–7. DOI: 10.1136/ard.60.2.91. PMID: 11156538. PMCID: 1753462.

4. Kim DH, Choi SS, Yoon SH, Lee SH, Seo DK, Lee IG, 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; 21:41–52. PMID: 29357330.

5. El-Hakeim EH, Elawamy A, Kamel EZ, Goma SH, Gamal RM, Ghandour AM, et al. Fluoroscopic guided radiofrequency of genicular nerves for pain alleviation in chronic knee osteoarthritis: a single-blind randomized controlled trial. Pain Physician. 2018; 21:169–77. PMID: 29565947.

6. Mata J, Valentí P, Hernández B, Mir B, Aguilar JL. Study protocol for a randomised controlled trial of ultrasound-guided pulsed radiofrequency of the genicular nerves in the treatment of patients with osteoarthritis knee pain. BMJ Open. 2017; 7:e016377. PMID: 29102985. PMCID: 5722097.

7. Choi WJ, Hwang SJ, Song JG, Leem JG, Kang YU, Park PH, et al. Radiofrequency treatment relieves chronic knee osteoarthritis pain: a double-blind randomized controlled trial. Pain. 2011; 152:481–7. DOI: 10.1016/j.pain.2010.09.029. PMID: 21055873.

8. Iannaccone F, Dixon S, Kaufman A. A review of long-term pain relief after genicular nerve radiofrequency ablation in chronic knee osteoarthritis. Pain Physician. 2017; 20:E437–44. PMID: 28339444.

9. Lee SJ, Park SC, Baek S, Yoon CS, Lee JH. Pulsed radiofrequency lesioning of the saphenous nerve in degenerative osteoarthritis of knee - a case report. Korean J Pain. 2003; 16:212–6.

10. Walega DR, McCormick ZL. Chemical neurolysis of the genicular nerves for chronic knee pain: reviving an old dog and an old trick. Pain Med. 2018; 19:1882–4. DOI: 10.1093/pm/pny023. PMID: 29514315.

11. Ahmed A, Arora D. Ultrasound-guided neurolysis of six genicular nerves for intractable pain from knee osteoarthritis: a case series. Pain Pract. 2019; 19:16–26. DOI: 10.1111/papr.12710. PMID: 29761638.

12. Tran J, Peng PWH, Lam K, Baig E, Agur AMR, Gofeld M. Anatomical study of the innervation of anterior knee joint capsule: implication for image-guided intervention. Reg Anesth Pain Med. 2018; 43:407–14. DOI: 10.1097/AAP.0000000000000778. PMID: 29557887.

13. Sar ıS, Aydın ON, Turan Y, Şen S, Özlülerden P, Ömürlü İK, et al. Which imaging method should be used for genicular nerve radio frequency thermocoagulation in chronic knee osteoarthritis? J Clin Monit Comput. 2017; 31:797–803. DOI: 10.1007/s10877-016-9886-9. PMID: 27142099.

14. 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:E751–9. PMID: 27389118.

15. DemIr Y, Güzelküçük Ü, Tezel K, AydemIr K, Taşkaynatan MA. A different approach to the management of osteoarthritis in the knee: ultrasound guided genicular nerve block. Pain Med. 2017; 18:181–3. DOI: 10.1093/pm/pnw177. PMID: 27492742.

16. Hirasawa Y, Okajima S, Ohta M, Tokioka T. Nerve distribution to the human knee joint: anatomical and immunohistochemical study. Int Orthop. 2000; 24:1–4. DOI: 10.1007/s002640050001. PMID: 10774852. PMCID: 3619852.

17. Roos EM, Lohmander LS. The Knee injury and Osteoarthritis Outcome Score (KOOS): from joint injury to osteoarthritis. Health Qual Life Outcomes. 2003; 1:64. DOI: 10.1186/1477-7525-1-64. PMID: 14613558. PMCID: 280702.