Genicular Nerve Block/Neurotomy Overview
Severe knee pain is a common complaint in people suffering from progressive diseases like Osteoarthritis. Pain is also common following a failed knee surgery like partial or total knee replacement.
For many people, chronic knee pain can be treated by blocking pain signals that are fed into the knee through the genicular nerves. This procedure is called Genicular Nerve Block or Neurotomy.
Genicular nerve block/neurotomy is a relatively new technique used to treat severe knee pain that has not responded to other treatments. There are typically 3 branches targeted with genicular nerve block – the superior medial branch, the superior lateral branch, and the interior medial genicular nerves.
What to expect after procedure:
You may notice some swelling or pain around the injection site, but should also notice that your typical knee pain is substantially less. The effects of the nerve block can last from a few hours to a few days. We tell most patients to take it easy the rest of the day, but you may return to normal activities as soon as you feel ready. If the nerve block is successful and your knee pain is substantially reduced, you are able to use less pain medication and you find yourself able to do more activity with less pain, then the nerve block is successful. Once you have successful nerve block your doctor will schedule you for the neurotomy (nerve deadening). This is a very similar procedure as above expect rather than numbing and blocking the nerve, the doctor will deaden the nerve with a special needle. This relief may last anywhere from 6 months to two years.
Risks:
Genicular nerve block/neurotomy is considered an appropriate non-surgical treatment for many patients who suffer from this type of pain. The procedure itself is very safe and has minimal risks. The risks are typically low, but can include misplacement of the needle, bleeding, infection, drug allergy, nerve damage and/or worsening pain. These are exceedingly rare.
Which Conditions Can Be Treated Using Genicular Nerve Block?
Conditions commonly treated with genicular nerve blocks:
- Knee Osteoarthritis – This type of arthritis is due to wear and tear on the knee joint
- Chronic knee pain – Chronic knee pain can be caused by tendinitis, injury, osteoarthritis, gout, or other conditions
- Degenerative Joint Disease
- Patients with pain after total or partial knee surgery
- Patients with chronic knee pain who are not surgical candidates
What To Expect From Your Procedure
Arrive 20 minutes prior to your appointment on procedure day. If you request sedation, our nurses will start an IV. They will also perform a preoperative assessment. Following your assessment, you will be taken to your procedure room where you will receive sedation to make you more comfortable.
A cleaning solution will be placed on your skin to help decrease chances of infection. The procedure site is then identified by your doctor under x-ray guidance. Once the site is identified, a shot of numbing medicine (typically bupivicaine) will be given to numb the skin. The shot may initially feel like a bee sting, but the sensation will last only a few seconds.
The spinal needle is then placed into the position using x-ray guidance. Medication consisting of a steroid (methylprednisilone) and local anesthetics (bupivicaine) is injected through the needle. This medication disperses and bathes the nerves. Most patients report some pain relief almost immediately. The needle is then removed and you will be taken to the recovery room. The procedure itself takes 10-15 minutes. You will be observed for an additional 15 minutes after the procedure is complete.
You may prefer to have someone drive you home following your procedure. However, it is not a requirement.
At PTCOA, we generally recommend that each patient take it easy after a nerve block, but you can return to normal activities as soon as you feel ready.
What To Expect After Your Procedure
You may notice mild swelling or pain at the injection site following your nerve block procedure. However, you should also notice a substantial decrease in typical knee pain. Pain relief usually lasts from a few hours to a few days.
A successful genicular nerve block will lessen your pain enough that you don’t require as much pain medication during the day. You will also experience less pain while performing normal activities.
After a successful nerve block, your pain doctor will schedule a neurotomy (nerve deadening) or radiofrequency ablation procedure.
The process for genicular nerve neurotomy is similar to a nerve block. However, instead of numbing and blocking the nerve, your doctor will deaden it with a special needle. Pain relief from neurotomy lasts anywhere from 6 months to two years.
Risks Associated With Genicular Nerve Block
Genicular nerve block/neurotomy is considered an appropriate non-surgical treatment for many patients who suffer from chronic knee pain. The procedure itself is safe and carries few risks. However, it’s always important to be aware of the risks that do exist.
The most common risks associated with genicular nerve block are:
- Misplacement of the needle
- Unexpected bleeding
- Drug allergy
- Infection
- Nerve damage
- Worsening pain
It’s important to remember that risks are exceedingly rare. With an experienced and trustworthy pain management doctor handling your procedure, the risks are even lower.