Ultrasound-Guided Genicular Nerve Pulsed Radiofrequency, Local Anesthetic with Steroid Genicular Nerve Block and Intra-Articular Botulinum Toxin Injection in The Management of Osteoarthritis Knee Pain
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https://doi.org/10.52783/jns.v14.3716Keywords:
N\AAbstract
Knee pain due to osteoarthritis (OA) is a common issue, affecting many elderly individuals. The knee joint receives sensory innervation from four genicular nerves (GN): the superior medial (SMGN), inferior medial (IMGN), superior lateral (SLGN), and inferior lateral (ILGN) genicular nerves. Various procedures target these nerves for pain relief, including corticosteroid and local anesthetic (LA) injections, pulsed radiofrequency (PRF), and intra-articular botulinum neurotoxin (IABoNTA). Genicular nerve block (GNB) and radiofrequency ablation (RFA) have gained popularity, even in patients post-total knee replacement (TKR). These techniques alleviate pain by inhibiting nerve fibers supplying the knee joint. The use of ultrasonography (US) has expanded in nerve block procedures due to its superior visualization of neurovascular structures compared to fluoroscopy. PRF applies alternating current to generate heat through molecular friction, creating a thermal lesion that disrupts pain transmission. RF neurotomy of the genicular nerves is a minimally invasive and safe approach for chronic knee OA. Botulinum neurotoxin has been well studied for its muscle-paralyzing effects via proteolysis of membrane-associated proteins, preventing acetylcholine release. However, emerging research indicates that intra-articular BoNT-A injections can reduce pain and improve joint function through anti-nociceptive mechanisms, offering an alternative for knee OA management.
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