Korean J Pain.  2025 Jan;38(1):81-84. 10.3344/kjp.24312.

Genicular nerve radiofrequency ablation: proposal of a technical protocol for managing procedural pain

• Rocha-Romero A
• Ng TKT
• Ferreira-Dos-Santos G

• KMID: 2563875
• DOI: http://doi.org/10.3344/kjp.24312

Figure

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  Fig. 1 Sonoanatomy and schematic diagrams illustrate the relationships between the branches of the anterior femoral cutaneous nerve (AFCN), the nerve to vastus medialis (NVM), the saphenous nerve, and the lateral femoral cutaneous nerve. For the block: The patient is positioned supine with the knee slightly flexed. Using a high-frequency linear transducer, the saphenous nerve is identified at the level of the apex of the femoral triangle. An in-plane, low-volume (around 3 mL) block is administered using an equal mixture of lidocaine with epinephrine and bupivacaine, carefully avoiding spread to the NVM. Before withdrawing the needle, the AFCN, including its medial and intermediate branches, is targeted above the sartorius muscle with a low-volume block of the same local anesthetic mixture. Time is allowed for the local anesthetic to take effect while the rest of the radiofrequency ablation setup is prepared. A: anterior, M: medial, P: posterior, L: lateral.

Reference

1. Karm MH, Kwon HJ, Kim CS, Kim DH, Shin JW, Choi SS. 2024; Cooled radiofrequency ablation of genicular nerves for knee osteoarthritis. Korean J Pain. 37:13–25. DOI: 10.3344/kjp.23344. PMID: 38155108. PMCID: PMC10764214.

2. Lee SH, Choi HH, Kwak SG, Chang MC. 2024; Effectiveness of radiofrequency ablation of the genicular nerves of the knee for the management of intractable pain from knee osteoarthritis. Pain Physician. 27:E419–29.

3. Alomari A, Bhatia A. 2024; An update on radiofrequency denervation for arthritis-related knee joint pain: a synthesis of the current evidence. BJA Educ. 24:164–72. DOI: 10.1016/j.bjae.2024.01.007. PMID: 38646452.

4. Huang Y, Deng Q, Yang L, Ma J, Wang Z, Huang D, et al. 2020; Efficacy and safety of ultrasound-guided radiofrequency treatment for chronic pain in patients with knee osteoarthritis: a systematic review and meta-analysis. Pain Res Manag. 2020:2537075. DOI: 10.1155/2020/2537075. PMID: 33014212. PMCID: PMC7520688.

5. Belba A, Vanneste T, Kallewaard JW, van Kuijk SM, Gelissen M, Emans P, et al. 2024; Cooled versus conventional radiofrequency treatment of the genicular nerves for chronic knee pain: 12-month and cost-effectiveness results from the multicenter COCOGEN trial. Reg Anesth Pain Med. doi: 10.1136/rapm-2023-105127. DOI: 10.1136/rapm-2023-105127. PMID: 38388017.

6. Rocha-Romero A, Ng TKT, Lam KHS. 2024; Optimizing genicular nerve chemical ablation. Korean J Pain. 37:275–9. DOI: 10.3344/kjp.24021. PMID: 38806179. PMCID: PMC11220382.

7. Rocha-Romero A. 2023; Diagnosis and treatment of post-radiofrequency synovial knee fistula: case report. A A Pract. 17:e01731. DOI: 10.1213/XAA.0000000000001731. PMID: 37991193.

8. Guven Kose S, Kirac Unal Z, Kose HC, Celikel F, Akkaya OT. 2023; Ultrasound-guided genicular nerve radiofrequency treatment: prospective randomized comparative trial of a 3-nerve protocol versus a 5-nerve protocol. Pain Med. 24:758–67. DOI: 10.1093/pm/pnad025. PMID: 36869680.

9. Schmitt K, Miller R, Nelson A, Alem N. 2024; How i do it: implementing virtual reality for genicular nerve radiofrequency ablation [Internet]. ASRA Pain Medicine. Available at: https://doi.org/10.52211/asra020124.012. DOI: 10.52211/asra020124.012.

10. Bjørn S, Nielsen TD, Moriggl B, Hoermann R, Bendtsen TF. 2020; Anesthesia of the anterior femoral cutaneous nerves for total knee arthroplasty incision: randomized volunteer trial. Reg Anesth Pain Med. 45:107–16. DOI: 10.1136/rapm-2019-100904. PMID: 31826920.

11. Bendtsen TF, Moriggl B, Chan V, Børglum J. 2016; The optimal analgesic block for total knee arthroplasty. Reg Anesth Pain Med. 41:711–9. DOI: 10.1097/AAP.0000000000000485. PMID: 27685346.