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. 2023 Sep 28;38(5):e550.
doi: 10.5001/omj.2023.103. eCollection 2023 Sep.

Effectiveness of Ultrasound-guided versus Anatomical Landmark-guided Genicular Nerve Block to Treat Chronic Knee Osteoarthritis: A Retrospective Cohort Study

Sarbhjit Singh  1 , Sarbhan Singh  2 , Maniventhan Nachimuthu  3 , Ahmad Fauzey Kassim  1 , Avreena Kaur Bhullar  4 , Rajkumar Veerakumaran  3 , Goh Ni Kol  3 , Nurul Azreen Mohd Roslan  3
Affiliations

Effectiveness of Ultrasound-guided versus Anatomical Landmark-guided Genicular Nerve Block to Treat Chronic Knee Osteoarthritis: A Retrospective Cohort Study

Sarbhjit Singh et al. Oman Med J. .

Abstract

Objectives: There is limited data on the relative effectiveness of different techniques used for administering genicular nerve block (GNB) for pain management of chronic knee osteoarthritis (OA) in the Malaysian population. This study aims to determine and compare the effectiveness of GNB administered using two pain management techniques?"anatomical landmark-guided (ALG) and ultrasound-guided (USG)?"for chronic knee OA in this population.

Methods: This retrospective cohort study included 40 patients with chronic knee OA who received GNB, 20 of whom underwent treatment with the USG technique and the other 20 with the ALG technique. Pain, stiffness, and functional limitation scores were assessed using the Western Ontario and McMaster Universities Osteoarthritis Index Questionnaire (WOMAC) and Numeric Rating Scale (NRS-11) at baseline and post-treatment day one, three weeks, and six weeks.

Results: Both groups reported a significant reduction in WOMAC and NRS-11 scores as per their feedback on day one, three weeks, and six weeks post-treatment. Greater reductions in WOMAC and NRS-11 scores were reported by patients who received GNB via USG than by ALG technique, the difference achieving statistical significance at six weeks after treatment (p =0.026).

Conclusions: GNB administration using USG and ALG techniques are both effective in significantly reducing pain, stiffness, and functional limitation in patients suffering from chronic knee OA. Among the two techniques, USG appears to be more effective. Nevertheless, GNB guided by ALG continues to be a viable treatment modality, especially in healthcare settings with limited to no USG facilities.

Keywords: Anatomical Landmark; Malaysia; Nerve Block; Osteoarthritis of Knee; Pain Management; Ultrasound.

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Figures

Figure 1
Figure 1
Flow chart depicting participant selection process.
Figure 2
Figure 2
Anterior view of the right knee showing the lines drawn for the anatomical landmark guided technique to deliver genicular nerve block which consists of injections targeting the superomedial genicular nerve (SMGN), superolateral genicular nerve (SLGN), and inferomedial genicularnerve (IMGN).
Figure 3
Figure 3
Ultrasound image of the superomedial genicular artery in the coronal plane.
Figure 4
Figure 4
Ultrasound image of the inferomedial genicular artery in the coronal plane.
Figure 5
Figure 5
Western Ontario and McMaster Universities Osteoarthritis Index Questionnaire (WOMAC) and Numeric Rating Scale (NRS-11) score comparison at baseline and post-treatment intervals among (a) all patients, (b) anatomical landmark-guided (n = 20), and (c) ultrasound-guided (n = 20) participants. (lower scores represent more relief experienced by the patient).
See this image and copyright information in PMC

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