scholarly journals Long-Term Retrospective Assessment of Clinical Efficacy of Radiofrequency Ablation of the Knee Using a Cooled Radiofrequency System

2019 ◽  
Vol 5 (22;5) ◽  
pp. 489-489
Author(s):  
Leonardo Kapural
Keyword(s):  
Chronic Pain ◽  
Radiofrequency Ablation ◽  
Pain Relief ◽  
Knee Pain ◽  
Controlled Trial ◽  
Real Life ◽  
Clinical Effectiveness ◽  
Opioid Use ◽  
Chronic Knee Pain

Background: Cooled radiofrequency ablation (CRFA) in a randomized, prospective study demonstrated significantly greater improvements in pain, functional, and global outcome measures. Objectives: This large, real-life, retrospective study evaluated the long-term effectiveness of CRFA in the general chronic knee pain population. Study Design: Retrospective electronic chart review. Setting: Outpatient private practice. Methods: After institutional review board approval, we reviewed data of 275 consecutive patients who had undergone a geniculate nerve block at a single-site pain practice between July 1, 2014 and July 1, 2017. A total of 44 patients had a negative response to the geniculate block, and 11 patients had long-term pain relief from the block and declined CRFA. Eight patients underwent knee surgery after the block, and 7 never followed up for further treatment. Finally, 205 patients had undergone CRFA, and 183 (89%) of them returned to provide data. Results: The average age of the 183 patients was 61 (28-95) years, body mass index 34 (18.5- 57), and there were 105 women and 78 men. A total of 137 patients had unilateral knee pain, whereas 46 patients had bilateral knee pain. Eighty percent (146/183) reported at least one or more additional sources of chronic pain (back, shoulder, and others). The average opioid use at baseline was 50 mg morphine sulfate equivalents (median 30 mg). The average baseline pain scores were 8.5, which decreased to 2.2 after the geniculate local anesthetic block, and to 4.2 after CRFA. A total of 65% of the patients claimed > 50% pain relief, whereas 77% had 2 or more Visual Analog Scale points decrease, and 26 (14%) patients reported no pain at all after CRFA. The mean duration of > 50% pain relief after CRFA was 12.5 months (range 0-35 months). There was no significant decrease of opioid use. Patients who underwent a repeated procedure (n = 43) achieved a similar pain relief (P = 0.402). We could not find a statistical difference in geniculate CRFA outcomes between the group who had total knee arthroplasty (TKA; n = 21) and maintained chronic knee pain and patients who had no prior surgery (P = 0.542). Limitations: Retrospective nature of the study. Conclusions: This study demonstrates the clinical effectiveness of CRFA in the treatment of chronic knee pain from osteoarthritis, and even in those patients who maintained chronic knee pain after TKA. Our real-life data seems to agree with data previously published in a randomized controlled trial, despite the fact that this was quite a heterogenous patient population with various sources of chronic pain. Key words: Radiofrequency ablation, chronic knee pain, knee osteoarthritis

Radiofrequency ablation of genicular nerves prior to total knee replacement has no effect on postoperative pain outcomes: a prospective randomized sham-controlled trial with 6-month follow-up

2019 ◽  
Vol 44 (6) ◽  
pp. 646-651 ◽  
Author(s):  
David Walega ◽  
Zachary McCormick ◽  
David Manning ◽  
Michael Avram
Keyword(s):  
Radiofrequency Ablation ◽  
Postoperative Pain ◽  
Knee Pain ◽  
Controlled Trial ◽  
Postoperative Pain Management ◽  
Opioid Use ◽  
Management Regime ◽  
Chronic Knee Pain ◽  
Pain Outcomes ◽  
Total Knee

Background and objectivesRefractory chronic knee pain from osteoarthritis (OA) is commonly treated with total knee arthroplasty (TKA). TKA can be associated with severe postoperative pain and persistent postsurgical knee pain. Poorly controlled postoperative pain can negatively effect functional outcomes following TKA, and effective opioid-sparing analgesia is key to the ideal recovery. Genicular nerve radiofrequency ablation (GN-RFA) has been shown in several trials to be clinically effective in patients with severe refractory knee pain from OA. We aimed to assess if preoperative GN-RFA would improve postoperative pain outcomes following TKA.MethodsThis was a sham-control prospective clinical trial in which blinded participants were randomized to image-guided GN-RFA or a simulated sham procedure 2-6 weeks prior to elective TKA. Outcomes were assessed at 48 hours and 1, 3 and 6 months following TKA.ResultsSeventy participants enrolled in this study. As compared with sham controls, GN-RFA had no treatment effect on postoperative opioid consumption, pain or functional measures at any time point.ConclusionsCooled RFA of the superior lateral, superior medial and inferomedial genicular nerves, when performed 2–6 weeks prior to elective TKA as part of a multimodal postoperative pain management regime, had no measurable effect on postoperative opioid use, analgesia use or function in the 48 hours following surgery. In addition, we found no longer term effect on outcome measures 1, 3 and 6 months after TKA.Trial registration numberNCT02746874.

scholarly journals The Long Term Effectiveness of Genicular Nerve Blocks for Chronic Knee Pain: A Retrospective Study

2018 ◽  
pp. 75-77
Author(s):  
Laura Anne Lynem
Keyword(s):  
Retrospective Study ◽  
Radiofrequency Ablation ◽  
Pain Relief ◽  
Knee Pain ◽  
Nerve Block ◽  
Nerve Blocks ◽  
Chronic Knee Pain ◽  
Post Procedure

Chronic knee pain is a leading cause of chronic disability and its symptoms have a profound impact on the lives of those suffering from it. Current treatment modalities for chronic knee pain include pharmacologic and nonpharmacologic interventions. Genicular nerve blocks are a new therapeutic alternative that have been shown to relieve chronic knee pain and may provide significant relief in patients who are either poor surgical candidates or are unwilling to accept the risks associated with surgery. Genicular nerve blocks may provide long term pain relief for chronic knee pain and radiofrequency ablation (RFA) may not be necessary. This Institutional Review Board (IRB) approved retrospective study conducted at a single center university hospital involved 44 patients aged 43 to 87 who received genicular nerve blocks for chronic knee pain. The primary purpose of this study was to determine if genicular nerve blocks provide effective long term pain relief for patients with chronic knee pain. The numeric rating scale was used to measure the patient’s knee pain at baseline, 30, 90, and 120 days post procedure. Patients experienced a mean pain level of 7.43 out of 10 before the genicular nerve block and 4.02 afterward representing an average improvement of 42.6% in pain relief overall post procedure follow-up. A t-test revealed a statistically significant difference between the mean pain score before and after the blocks (t = 8.534, P < 0.01). Overall, the patients experienced significant pain relief of an average of 111.9 days resulting in an average of 42.6 percent pain relief post procedure follow-up. Out of the 44 patients, 15 (34.1%) underwent a RFA after receiving a genicular nerve block procedure to further manage their chronic knee pain symptoms. In conclusion, we have found statistically significant evidence that genicular nerve blocks provide effective long-term pain relief for patients with chronic knee pain. Therefore, for patients who are not surgical candidates, genicular nerve blocks represent a viable alternative treatment for knee pain. Key words: Genicular nerve blocks, chronic knee pain, genicular nerves, genicular nerve radiofrequency ablation

scholarly journals A Review of Long-Term Pain Relief after Genicular Nerve Radiofrequency Ablation in Chronic Knee Osteoarthritis

2017 ◽  
Vol 3 (20;3) ◽  
pp. E437-E444 ◽  
Author(s):  
Ferdinand Iannaccone
Keyword(s):  
Radiofrequency Ablation ◽  
Pain Relief ◽  
Pain Score ◽  
Knee Pain ◽  
Study Design ◽  
Chart Review ◽  
Health Sciences ◽  
Chronic Knee Pain

Background: Studies of radiofrequency ablation (RFA) of genicular nerves have reportedly significantly decreased pain up to 3 months post ablation, but no longer term effects have been reported. We performed an analysis of long-term pain relief of 31 RFA procedures of the genicular nerves to analyze the degree of pain relief past 3 months, culminating at 6 months. Objective: To evaluate the long term efficacy of genicular nerve ablation for management of chronic knee pain due to osteoarthritis. Study Design: Chart review and study design was approved by Newark Health Sciences IRB. Chart review and follow-up was performed on all patients who underwent genicular nerve RFA during the period of February 2014 through August of 2015. During this inclusion period 41 genicular nerve RFAs were performed on 31 patients, 5 patients received RFA procedure in both knees. Patient follow-up was performed via telephone interview or in-office visit at least 3 months and 6 months post RFA. Settings: Procedures were performed in Medical Special Procedures at University Hospital in Newark, NJ, and the Pain Management Center at Overlook Medical Arts Center in Summit, NJ. Methods: Chart review and study design was approved by Newark Health Sciences Institutional Review Board. Chart review was performed from February 2014 and continued through August 2015. Patient follow-up was conducted at 3 and at least 6 months post treatment to gauge degree of pain relief (0 – none, 100% – complete), their current day’s pain score, other treatment modalities tried before RFA, and the medications used. Patients were asked to quantify their satisfaction with procedure length, pre-procedure anxiety, complications, and if they would recommend this procedure to others. Primary and secondary goals were the duration of pain relief after RFA, the quality of pain relief, and the efficacy of our approach for RFA of genicular nerves versus prior published techniques. Results: At 3 month follow-up, the average pain relief was 67% improvement from baseline knee pain, 0% being no relief and 100% being complete relief, and average 0 – 10 pain score was 2.9. At 6 month follow-up, of those who described pain relief at 3 months, 95% still described pain relief. This group’s average percent pain relief was 64% and average day’s 0 – 10 pain score 3.3. Limitations: Our study included a retrospective component in chart review followed by prospective follow-up, only 76% of patients were able to participate in the interview process. Furthermore, some patients suffered from other chronic pain ailments, most commonly chronic back pain, which at times disturbed the patient’s ability to focus on solely knee pain. Conclusions: Based on patient interviews and data collection, RFA of genicular nerves can supply on average greater than 60% pain relief in our patient population for as long as 6 months. Key words: Osteoarthritis, knee osteoarthritis, chronic knee pain, radiofrequency ablation, nerve ablation, genicular nerves, long-term pain relief

scholarly journals Genicular Nerve Radiofrequency Ablation and Dual Subsartorial Block for Chronic Knee Pain Post Total Knee Replacement: A Case Report

2022 ◽  
Vol 2 (2) ◽  
pp. 253-257
Author(s):  
Aidyl Fitrisyah ◽  
Stevanus Eliansyah Handrawan ◽  
Nurlaili Maya Ramadhanty
Keyword(s):  
Chronic Pain ◽  
Radiofrequency Ablation ◽  
Total Knee Replacement ◽  
Knee Pain ◽  
Knee Replacement ◽  
Rating Scale ◽  
Womac Score ◽  
Assessment Tools ◽  
Chronic Knee Pain ◽  
Total Knee

Introduction. Chronic pain defines as pain persisting for three months or longer, chronic post-surgical pain can affect all dimensions of health-related quality of life, and is associated with functional limitations. treatment of chronic pain after total knee replacement is challenging, and evaluation of combined treatments and individually targeted treatments matched to patient characteristic. Genicular nerve block radiofrequency ablation is a safe and effective therapeutic procedure for pain associated with chronic pain due to knee osteoarthritis, and the evolution of newer regional analgesia techniques aids in reducing postoperative pain Dual Subsartorial Block (DSB) as a procedure specific, post total knee replacemet. historically there has been a reliance on using a pain-spesific assessment tools Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Case Presentation. A 55-year old woman admitted she had pain on bilateral knee, the knee pain had affected her daily living, she was diagnosed with chronic knee pain post TKR because of osteoarthritis genu bilateral, the patient was planning genicular nerve radiofrequency ablation and dual subsartorial block, from the examination we found that numeric rating scale was 6 (moderate pain) with WOMAC score 76, before the procedure the patients are examined through radiology for any deformity in the knee. The genicular nerve radiofrequency ablation under ultrasound guidance on bonylandmark, resulting anesthesia of the anterior compartment of the knee, and dual subsartorial block that cover almost all the innervations of pain generating component of the anterior and posterior knee joint involved in TKR surgery. After the procedure we reevaluated the pain score using NRS was 2 (mild pain), and with WOMAC Score 19. Conclusion. Treatment of chronic pain post total knee replacemet was challenging, targeted treatment may ameliorate the pain and prevent long term disability.  

Evaluating predictors of pain reduction after genicular nerve radiofrequency ablation for chronic knee pain

2021 ◽  
Author(s):  
Annie Philip ◽  
Mark Williams ◽  
Jenae Davis ◽  
Avinash Beeram ◽  
Changyong Feng ◽  
...  
Keyword(s):  
Radiofrequency Ablation ◽  
Pain Relief ◽  
Knee Pain ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Pain Reduction ◽  
Nerve Blocks ◽  
Chronic Knee Pain ◽  
Pain Outcomes ◽  
Pain Improvement

Aim: Radiofrequency ablation (RFA) of genicular nerves can treat refractory chronic knee pain. This study evaluated association between patient and procedural characteristics and pain improvement after genicular nerve RFA. Materials & methods: A retrospective chart review. Data were extracted from patients who underwent thermal or cooled RFA of the knee. Results: A total of 124 patients were included. 81% of patients reported ≥75% pain relief after diagnostic nerve blocks. 35% reported ≥50% pain reduction from the RFA. Predictors of improved pain outcomes included higher baseline pain, no depression and thermal (vs cooled) RFA. Conclusion: Identifying patients who may benefit the most from genicular RFA is still not clear. Pain reduction differences between patients with and without depression and RFA type deserves further exploration.

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