Advertisement

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

  • Julia Sobel
    Affiliations
    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
    Search for articles by this author
  • Jessica Oswald
    Correspondence
    Reprint Address: Jessica Oswald, MD, MPH, Department of Anesthesiology & Pain Management, UC San Diego Health, 9400 Campus Point Drive, La Jolla, CA 92037
    Affiliations
    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
    Search for articles by this author

      Abstract

      Background

      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.

      Keywords

      To read this article in full you will need to make a payment

      References

        • Beaudoin FL
        • Nagdev A
        • Merchant RC
        • Becker BM.
        Ultrasound-guided femoral nerve blocks in elderly patients with hip fractures.
        Am J Emerg Med. 2010; 28: 76-81
        • Bhoi S
        • Chandra A
        • Glawankar S.
        Ultrasound-guided nerve blocks in the emergency department.
        J Emerg Trauma Shock. 2010; 3: 82-88
        • Ahmed A
        • Arora D.
        Ultrasound-guided radiofrequency ablation of genicular nerves of knee for relief of intractable pain from knee osteoarthritis: a case series.
        Br J Pain. 2017; 12: 145-154
        • Caldwell Jr, GL
        • Selepec MA.
        Reduced opioid use after surgeon-administered genicular nerve block for anterior cruciate ligament reconstruction in adults and adolescents.
        HSS J. 2019; 15: 42-50
        • Cankurtaran D
        • Karaahmet OZ
        • Yildiz SY
        • Eksioglu E
        • Dulgeroglu D
        • Unlu E.
        Comparing the effectiveness of ultrasound guided versus blind genicular nerve block on pain, muscle strength with isokinetic device, physical function and quality of life in chronic knee osteoarthritis: a prospective randomized controlled study.
        Korean J Pain. 2020; 33: 258-266
        • Protzman N
        • Gyi J
        • Malhotra AD
        • Kooch JE.
        Examining the feasibility of radiofrequency treatment for chronic knee pain after total knee arthroplasty.
        PM R. 2014; 6: 373-376
        • Sahoo RK
        • Krishna C
        • Kumar M
        • Nair AS.
        Genicular nerve block for postoperative pain relief after total knee replacement.
        Saudi J Anaesth. 2020; 12: 235-237
      1. Demir G, Güzelküçük U, Tezel K, AydemIr K, Taşkaynatan MA. A different approach to the management of osteoarthritis in the knee: ultrasound guided genicular nerve block. Pain Med 18:181–3. https://doi.org/10.1093/pm/pnw177. Accessed June 01, 2021

        • Holland WC.
        A prospective evaluation of shared decision-making regarding analgesics selection for older emergency department patients with acute musculoskeletal pain.
        Acad Emerg Med. 2017; 23: 306-314
        • Kim DH
        • Choi SS
        • Yoon SH
        • 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
        • Fonkoué L.
        Distribution of sensory nerves supplying the knee joint capsule and implications for genicular blockade and radiofrequency ablation: an anatomical study.
        Surg Radiol Anat. 2019; 41: 1461-1471
        • Erdem Y
        • Sir E.
        The efficacy of ultrasound-guided pulsed radiofrequency of genicular nerves in the treatment of chronic knee pain due to severe degenerative disease or previous total knee arthroplasty.
        Med Sci Monit. 2019; 25: 1857-1863
        • Gadsen J.
        Local anesthetics: clinical pharmacology and rational selection.
        The New York School of Regional Anesthesia. October 2013; (Available at: . Accessed June 01, 2021)