Korean J Pain.  2023 Oct;36(4):450-457. 10.3344/kjp.23200.

Comparison of the efficacy of genicular nerve phenol neurolysis and radiofrequency ablation for pain management in patients with knee osteoarthritis

• Yildiz G
• Perdecioglu GRG
• Yuruk D
• Can E
• Akkaya OT

• KMID: 2546707
• DOI: http://doi.org/10.3344/kjp.23200

Abstract

Background
Genicular nerve neurolysis with phenol and radiofrequency ablation (RFA) are two interventional techniques for treating chronic refractory knee osteoarthritis (KOA) pain. This study aimed to compare the efficacy and adverse effects of both techniques.
Methods
Sixty-four patients responding to diagnostic blockade of the superior medial, superior lateral, and inferior medial genicular nerve under ultrasound guidance were randomly divided into two groups: Group P (2 mL phenol for each genicular nerve) and Group R (RFA 80°C for 60 seconds for each genicular nerve). The numeric rating scale (NRS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were used to evaluate the effectiveness of the interventions.
Results
RFA and phenol neurolysis of the genicular nerves provided effective analgesia within groups at 1 week, 1 month, and 3 months compared to baseline. There was no significant difference between the groups in terms of NRS and WOMAC scores at all measurement times. At the 3rd month follow-up, 50% or more pain relief was observed in 53.1% of patients in Group P and 50% of patients in Group R. The rate of transient paresthesia was 34.4% in Group P and 6.3% in Group R, and this was significantly higher in Group P.
Conclusions
Neurolysis of the genicular nerves with both RFA and phenol is effective in the management of KOA pain. Phenol may be a good alternative to RFA. Further studies are needed on issues such as dose adjustment to prevent transient paresthesia response.

Keyword

Analgesia; Chronic Pain; Nerve Block; Neuritis; Osteoarthritis, Knee; Paresthesia; Phenol; Radiofrequency Ablation

Figure

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  Fig. 1 Probe placement for superior medial genicular nerve, superior lateral genicular nerve, and inferior medial genicular nerve. SMGA: superior medial genicular artery, SLGA: superior lateral genicular artery, IMGA: inferior medial genicular artery.

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  Fig. 2 Patients flow chart.

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  Fig. 3 (A) Numeric rating scale (NRS) and (B) Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores of the groups before and after the treatment. The NRS is shown as the median (min-max range), and WOMAC score is shown as the mean ± standard deviation. aP < 0.001 for NRS-1st week, 1st month and 3rd month compared to NRS-baseline. bP < 0.001 for WOMAC-1st week, WOMAC-1st month and WOMAC-3rd month compared to WOMAC-baseline.

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