Korean J Pain.  2022 Apr;35(2):183-190. 10.3344/kjp.2022.35.2.183.

Comparison of ultrasound guided pulsed radiofrequency of genicular nerve with local anesthetic and steroid block for management of osteoarthritis knee pain

• Ghai B
• Kumar M
• Makkar JK
• Goni V

• KMID: 2527769
• DOI: http://doi.org/10.3344/kjp.2022.35.2.183

Abstract

Background
To compare ultrasound-guided pulsed radiofrequency (PRF) of the genicular nerve with the genicular nerve block using local anesthetic and steroid for management of osteoarthritis (OA) knee pain.
Methods
Thirty patients with OA knee were randomly allocated to receive either ultrasound-guided PRF of the genicular nerve (PRF group) or nerve block with bupivacaine and methylprednisolone acetate (local anesthetic steroid [LAS] group). Verbal numeric rating scale (VNRS) and Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) scores were measured at pre-procedure and 1-, 4-, and 12-weeks post-procedure.
Results
VNRS scores decreased significantly (P < 0.001) in both the groups at 12 weeks and other follow up times compared to baseline. Seventy-three percent of patients in the PRF group and 66% in the LAS group achieved effective pain relief (≥ 50% pain reduction) at 12 weeks (P > 0.999). There was also a statistically significant (P < 0.001) improvement in WOMAC scores in both groups at all follow up times. However, there was no intergroup difference in VNRS (P = 0.893) and WOMAC scores (P = 0.983). No complications were reported.
Conclusions
Both ultrasound-guided PRF of the genicular nerve and blocks of genicular nerve with local anesthetic and a steroid provided comparable pain relief without any complications. However, PRF of the genicular nerve is a procedure that takes much more time and equipment than the genicular nerve block.

Keyword

Anesthetics; Local; Chronic Pain; Knee; Nerve Block; Osteoarthritis; Pain Management; Pulsed Radiofrequency Treatment; Steroids; Ultrasonography; Interventional

Figure

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  Fig. 1 CONSORT (Consolidated Standards of Reporting Trials) diagram showing flow of patients.

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  Fig. 2 Box plot analysis of VNRS scores at various time intervals. Boxplots show the median, interquartile range and outliers. Box edge indicates 25th and 75th percentiles, Whiskers indicate 5th and 95th percentiles. Red/blue dots represent outliers. Within group comparison, VNRS score were significant in both the PRF group and LAS group at various time interval of follow-up. Error bars indicate 95% confidence interval. VNRS: verbal numeric rating scale, PRF: pulsed radiofrequency, LAS: local anesthetic steroid. * indicates P < 0.001 compared to baseline in PRF group. $ indicates P < 0.001 compared to baseline in LAS group.

• 

  Fig. 3 Box plot analysis of WOMAC score at various time intervals. Boxplots show the median, interquartile range and outliers. Box edge indicates 25th and 75th percentiles, Whiskers indicate 5th and 95th percentiles. Red/blue dots represent outliers. Within group comparison, WOMAC score were significant in both the PRF group and LAS group at various time interval of follow-up. Error bars indicate 95% confidence interval. WOMAC: Western Ontario and McMaster Universities Arthritis Index, PRF: pulsed radiofrequency, LAS: local anesthetic steroid. * indicates P < 0.05 compared to baseline in PRF group. $ indicates P < 0.05 compared to baseline in LAS group.

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