Genicular Nerve Block for Pain Management in Patients With Knee Osteoarthritis: A Randomized Placebo‐Controlled Trial. Issue 2 (11th November 2022)

• Record Type: Journal Article
• Authors: Shanahan, Ernst M.; Robinson, Lucinda; Lyne, Suellen; Woodman, Richard; Cai, Fin; Dissanayake, Kokum; Paddick, Kate; Cheung, Giovanna; Voyvodic, Frank
• Is Part Of: Arthritis & rheumatology. Volume 75:Issue 2(2023)
• Page Start: 201
• Page End: 209
• Publication Date: 2022-11-11
• Subjects: Arthritis -- Periodicals; Rheumatism -- Periodicals; 616.72
• DOI: 10.1002/art.42384
• Languages: English
• ISSNs: 2326-5191

Abstract

Abstract : Objective: This study was undertaken to determine the efficacy of ultrasound‐guided genicular nerve block (GNB) for the management of knee pain in patients with knee osteoarthritis. Methods: We performed a 12‐week parallel‐group, placebo‐controlled randomized trial of GNB. Within 2 weeks of randomization, patients with knee osteoarthritis in the active arm received 3 injections of 5.7 mg celestone chronodose (1 ml) and 0.5% bupivacaine (3 ml) to the inferomedial, superomedial, and superolateral genicular nerves; patients with knee osteoarthritis in the placebo arm received injections of normal saline. At baseline and at weeks 2, 4, 8, and 12, patients recorded their pain and disability on a 100‐mm visual analog scale (VAS) (the primary outcome measure), the Western Ontario and McMasters Universities Osteoarthritis Index (WOMAC), and the Intermittent and Constant Osteoarthritis Pain scale. Statistical significance was set at a 2‐sided Type I error of α = 0.0125 for comparisons at each of the 4 time points. We used a global perceived effect scale to measure patient satisfaction. Results: The 59 patients (36 female, 23 male) who completed the trial had a mean ± SD age of 68.2 ± 8.6 years. Patients in the active group reported improvements in pain scores at 2, 4, 8, and 12 weeks with a diminution of the effect over time. VAS scores at baseline and at weeks 2, 4, 8, and 12 in the active group (n = 31) versus placebo group (n = 28) were 6.2 versus 5.3 ( P = 0.294), 2.7 versus 4.7 ( P < 0.001), 3.2 versus 5.1 ( P < 0.001), 3.9 versus 4.9 ( P < 0.001), and 4.6 versus 5.1 ( P = 0.055), respectively. Total WOMAC scores at baseline and at weeks 2, 4, 6, 8, and 12 in the active group versus the placebo group were 54.5 versus 48.1 ( P = 0.177), 32.9 versus 44.4 ( P < 0.001), 33.7 versus 45.8 ( P < 0.001), 39.2 versus 44.8 ( P = 0.001), and 42.65 versus 45.1 ( P = 0.012), respectively. Conclusion: GNB offers short‐term pain relief for knee osteoarthritis.