Novel Use of 3-Point Genicular Nerve Block for Acute Knee Pain in the Emergency Department

  • Julia Sobel
    Department of Emergency Medicine, UC San Diego Health, San Diego California and †Center for Pain Medicine, Department of Anesthesiology, UC San Diego Health, La Jolla, California
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  • Jessica Oswald
    Reprint Address: Jessica Oswald, MD, MPH, Department of Anesthesiology & Pain Management, UC San Diego Health, 9400 Campus Point Drive, La Jolla, CA 92037
    Department of Emergency Medicine, UC San Diego Health, San Diego California and †Center for Pain Medicine, Department of Anesthesiology, UC San Diego Health, La Jolla, California
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      Ultrasound-guided genicular nerve blocks (GNBs) in the emergency department (ED) have easily identifiable anatomic targets and offer an opportunity to provide safe, effective, motor-sparing analgesia for acute knee pain.
      Case Report A 68-year-old woman presented with acute, 8/10 right knee pain due to an isolated right lateral tibial plateau fracture. After informed consent and with the ultrasound in the sagittal plane, the superior lateral (SLGN), superior medial (SMGN), and inferior medial (IMGN) genicular nerves were identified at the junction of their respective femoral or tibial epicondyle and femoral or tibial epiphysis. The skin was anesthetized and an echogenic needle was inserted under ultrasound guidance to inject 1.0 mL of 0.5% bupivacaine around the right SLGN, SMGN, and IMGN. Approximately 30 minutes after the GNBs, the patient reported 0/10 pain at rest and 1/10 pain with movement. She did not require opioids during her ED visit or upon discharge.
      Why Should an Emergency Physician Be Aware of This? GNBs show promise as a useful tool to provide acute and medium-term motor-sparing analgesia in a patient with acute knee pain. GNBs have easy-to-recognize anatomic targets on ultrasound and may be a suitable adjunct or alternative to a multimodal pain regimen in the emergency department.


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