Genicular Nerve Blocks for Chronic Knee Pain

What Are Genicular Nerve Blocks?

Genicular nerve blocks are a type of procedure used to diagnose and manage knee pain. They are similar to genicular nerve denervation procedures, which are radiofrequency ablation (RFA) or pulsed radiofrequency (PRF). This technique stops pain signals by blocking the nerve itself, which is done by disabling a small part of the nerve tissue through a process called ablation.

During a genicular nerve block, a local anaesthetic (numbing medication) is injected near the genicular nerves, which are nerves around the knee joint. This temporary numbing effect helps to determine if these nerves are contributing to the pain. 

Genicular nerve blocks are generally used for diagnostic purposes to identify the source of knee pain such that therapeutic interventions like genicular pulsed radiofrequency denervation therapy can be offered. They are often performed as part of a comprehensive pain management plan for conditions such as osteoarthritis or other knee-related issues.

What Is Genicular Pulsed Radiofrequency Denervation?

Genicular nerve ablation or Pulsed radiofrequency denervation (PRF) of the genicular nerves, is a minimally invasive procedure aimed at providing long-lasting relief from knee pain, particularly associated with conditions like osteoarthritis. 

During the procedure, a specialised needle is guided into the knee joint under imaging guidance, such as fluoroscopy or ultrasound. Once in place, the needle delivers thermal energy, typically pulsed radiofrequency, to the genicular nerves responsible for transmitting pain signals from the knee. This energy effectively disrupts their ability to transmit pain signals. 

By interrupting the pain pathway, genicular pulsed radiofrequency denervation can provide significant and sustained pain relief, often lasting several months to a year or more. 

Genicular pulsed radiofrequency denervation is considered a safe and effective option for patients who have not found adequate relief from more conservative treatments like medication or physical therapy, and who cannot or choose not to go the surgical route. 

How Are Genicular Nerve Blocks Different From Genicular Pulsed Radiofrequency Denervation?

The main difference between a genicular nerve block and genicular pulsed radiofrequency denervation lies in their purpose and long-term effects. A genicular nerve block is considered to be a diagnostic tool and a temporary solution to help determine the source of knee pain, while genicular nerve ablation is designed to provide long term relief from chronic knee pain.  

• Genicular Nerve Block:
  • Purpose: A genicular nerve block is primarily diagnostic. It involves injecting a local anaesthetic near the genicular nerves to temporarily block pain signals. This helps determine if these nerves are the source of knee pain.
  • Duration: The effects of a genicular nerve block are temporary and typically last for several hours to a few days, depending on the type and amount of medication used.
  • Outcome: It helps to diagnose the source of knee pain and may provide temporary relief, but it is not a long-term solution.
• Genicular Pulsed Radiofrequency Denervation:
  • Purpose: Genicular pulsed radiofrequency denervation, also known as genicular nerve ablation is a therapeutic procedure aimed at providing long-term pain relief. It involves using radiofrequency waves to disrupt the genicular nerves, thereby interrupting the transmission of pain signals.
  • Duration: The effects of genicular pulsed radiofrequency denervation can last much longer than a nerve block, ranging from several months to a year or more, depending on individual factors and the specific technique used.
  • Outcome: Genicular pulsed radiofrequency denervation aims to provide lasting pain relief by disabling the genicular nerves’ ability to transmit pain signals. It is considered a more permanent solution compared to nerve blocks and may be recommended for individuals with chronic knee pain, particularly due to conditions like osteoarthritis.

While both genicular nerve blocks and genicular pulsed radiofrequency denervation involve targeting the genicular nerves to alleviate knee pain, their purposes, durations, and outcomes differ significantly. Nerve blocks are primarily diagnostic and provide temporary relief, whereas denervation is a therapeutic procedure aimed at providing longer-term pain management.

Why Would You Need A Genicular Nerve Block or Genicular Denervation?

If you are suffering from chronic knee pain and wish to avoid surgery or the ongoing use of medication or other nerve blocks, a genicular nerve block or genicular pulsed radiofrequency denervation may be a good choice to alleviate your knee pain.

Patients with persistent knee pain due to osteoarthritis, who have had a knee replacement failure or are otherwise unsuitable for knee replacement surgery may also benefit from this procedure. 

Risks of Getting a Genicular Nerve Block

Genicular nerve blocks are generally considered safe procedures when performed by experienced pain management specialists. 

However, like any medical procedure, there are potential risks and complications associated with these blocks, and it is essential to discuss these risks with your doctor before undergoing the procedure. 

Here are some of the potential risks and complications:

• Injection Site Reactions. Some patients may experience temporary pain, discomfort, or bruising at the injection site.
• Flare up of pain. There may be a temporary flare up of pain which is usually a ‘pressure effect’ from the injection.
• Infection.  Any invasive procedure carries a risk of infection. Though rare, infection can occur at the injection site or in the surrounding tissues, leading to complications that may require further treatment. Signs of infection include increased pain, swelling, redness, or drainage from the injection site.
• Bleeding. There is a risk of bleeding at the injection site, especially for patients taking blood-thinning medications. 
• Allergic Reactions. Allergic reactions to the medications used in the injection, such as local anaesthetics or corticosteroids, are possible but uncommon.
• Nerve Damage. Although rare, there’s a risk of nerve damage due to needle placement (direct trauma), the medication injected, infection or bleeding. Symptoms may include numbness, tingling, weakness, or increased pain. Some patients may experience temporary nerve irritation or exacerbation of pain following the injection, which usually resolves on its own.
• Exposure to X-Rays and CT. Minimal doses of radiation are used to reduce the lifetime risk of long term complications (such as cancer) due to exposure to X Ray and/ or CT scanning.
• Failure. The procedure may not provide the expected result or benefit.
• Sedation anaesthesia. There are risks of undergoing the sedation anaesthetic which is discussed on the day by the anaesthetist. Anaesthesia is generally very safe but there may be increased risk depending on your specific medical conditions.

Your doctor will assess your individual risk factors, discuss the potential risks with you, and take precautions to minimise these risks.

It’s essential to follow all pre-procedure and post-procedure instructions provided by your doctor and inform them immediately if you experience any unusual symptoms or complications following the injection. Regular communication is key to ensuring a safe and effective genicular nerve block procedure.

The Genicular Nerve Denervation And Nerve Block Procedures

At Persistent Pain Solutions, a genicular nerve pulsed radiofrequency denervation is performed using sedation anaesthesia to ease discomfort. Typically, the procedure takes 30 mins to perform.

During the procedure, the patient lies on their back with the affected knee elevated on a small pillow. Small needles are inserted into the knee, guided by x-ray imaging to ensure precise placement.

Once the needles are in position, electrodes are inserted through them to stimulate the nerve, causing a tingling sensation that confirms correct placement and indicates successful pain blockage.

Following confirmation, a low pulsed radiofrequency current is applied through the electrodes, to deactivate the targeted nerve segment. Multiple nerve locations may be treated if necessary.

A diagnostic nerve block is usually conducted a few weeks prior to the procedure. This involves injecting local anaesthesia into the knee to assess the potential success of the denervation procedure in pain reduction. The procedure is similar to genicular denervation but lacks the targeted radiofrequency currents or ablation aspects. 

After completion, patients are usually discharged following a brief observation period. Patients will need to arrange transportation home, as temporary effects of anaesthesia may impair driving ability.

Preparing for a Genicular Nerve Block (Pre-Op)

A genicular nerve block or genicular pulsed radiofrequency denervation procedure requires anaesthesia. 

Preparing for a genicular nerve block at the Persistent Pain Solutions clinic will require close communication with Dr Mittal and her team. 

Be sure to disclose all medications you may be taking and note that you may have to discontinue some or all of them immediately prior to the procedure.

Prior to your appointment, please inform us if:

• You are currently taking antibiotics.
• You have a pacemaker or defibrillator.
• You have any allergies.
• You have diabetes.
• You are taking any blood thinning medications.
• You are feeling unwell, as we may need to reschedule your procedure.

You must also avoid eating or drinking anything in the six hours leading up to the procedure. However, you may continue to take medications with a small sip of water on the morning of the procedure. You will be advised to cease some other medications such as those for diabetes and blood thinning medications.

For your safety, we recommend arranging transportation to and from your appointment, as driving yourself is not advised within the 24-hour period following the procedure.

We generally recommend you take leave from work on the day of the procedure AND one day after the procedure, to rest and recover from the procedure. 

If you are receiving genicular nerve blocks, we advise you to refrain from undergoing any additional medical procedures, such as dental treatments or colonoscopies, within 48 hours before or after receiving a genicular nerve block. 

Dr Meena Mittal and her team will provide specific guidance tailored to your situation. It’s important to adhere to your instructions diligently. If you have any concerns or queries, don’t hesitate to ask—we’re here to support you throughout the process.

After a Genicular Nerve Block (Post-Op Follow-Up)

Following your genicular nerve block procedure, you are free to return home. 

There are no specific restrictions on your day-to-day activities. However, it’s advisable to prioritise rest and engage in gentle activities during the initial 24 hours after your procedure.

Occasionally, you may experience some discomfort or bruising at the injection sites. Occasionally there is a temporary flare up of the pain.

You may commence physiotherapy one week after the procedure. You may return to hydrotherapy or a swimming pool/ spa two weeks after the procedure. 

We do not recommend any long distance or overseas travel for at least two weeks after the procedure. This is such that any issues or complications can be monitored and addressed in a timely manner. 

A follow-up appointment will be scheduled at 2 weeks post procedure to assess your response to the genicular nerve block. You will be requested to bring the post procedure Pain Chart such that the results can be analysed by Dr Mittal and next steps in your treatment plan can be discussed with you. 

Finding a Knee Pain Specialist Near You

If you are suffering from chronic knee pain due to osteoarthritis, a failed knee replacement surgery, or other knee issues and wish to avoid surgery, then a pain specialist who can perform a genicular nerve block may be able to provide some short term relief, potentially followed by a genicular pulsed radiofrequency denervation for more long term knee pain management. 

Asking your general practitioner for a referral to a pain specialist who offers genicular nerve blocks and genicular pulsed radiofrequency denervation and similar treatments is a good start; you can also speak to family members, friends, or support groups (both online and in real life) for recommendations from those who have dealt with similar painful knee problems. 

Genicular Nerve Blocks at Persistent Pain Solutions

Persistent Pain Solutions provides genicular nerve blocks and genicular pulsed radiofrequency denervation, two procedures designed to alleviate knee pain stemming from conditions like osteoarthritis. 

These methods target the genicular nerves surrounding the knee. Genicular nerve blocks provide temporary relief and serve as a diagnostic tool for genicular denervation, which is also known as radiofrequency ablation (RFA) or pulsed radiofrequency (PRF). By utilising ablation, a technique where a small portion of nerve tissue is incapacitated, we effectively interrupt pain signals, providing lasting knee pain relief for our patients.