Genicular Nerve Block

What is a Genicular Nerve Block?

A genicular nerve block is a minimally invasive procedure used to manage chronic knee pain, particularly when other treatments have not provided sufficient relief. During the procedure, a physician injects a local anesthetic and sometimes a steroid medication around the genicular nerves that supply sensation to the knee joint. By temporarily blocking these nerves, the procedure aims to alleviate pain and improve mobility in the knee. Genicular blocks are often considered as part of a comprehensive pain management plan and may be repeated periodically for sustained relief.

Genicular Nerve Block

During a genicular block procedure, the patient typically lies on their back or stomach on an examination table. The physician first cleans the skin around the knee and applies a local anesthetic to numb the area. Using fluoroscopy or ultrasound guidance for accuracy, the physician then inserts a thin needle into specific points around the knee to access the genicular nerves.

Once the needle is correctly positioned, a combination of local anesthetic and sometimes a steroid medication is injected around the genicular nerves. This medication temporarily interrupts the pain signals transmitted by these nerves, providing relief for the patient. The entire procedure usually takes around 15 to 30 minutes.

After the injection, the patient may feel immediate pain relief, although the full effect of the medication may take a few days to kick in. Some patients experience temporary numbness or weakness in the leg after the procedure, but this typically resolves quickly.

Overall, a genicular block is a relatively safe and effective way to manage chronic knee pain without the need for surgery.

While genicular block procedures are generally considered safe, there are some potential risks and side effects, including:

  1. Bleeding or bruising at the injection site: This is usually minor and resolves on its own.

  2. Infection: Although rare, there is a small risk of infection at the injection site. Proper sterile techniques are used to minimize this risk.

  3. Nerve injury: There is a small risk of inadvertently damaging nearby nerves during the procedure, which could lead to temporary or, in rare cases, permanent numbness, weakness, or other neurological symptoms.

  4. Allergic reaction: While uncommon, some patients may have an allergic reaction to the medications used during the procedure.

  5. Increased pain: In some cases, the injection may exacerbate the pain temporarily before providing relief, although this is rare.

  6. Elevated blood sugar levels: For patients with diabetes, corticosteroid injections used in genicular blocks can temporarily raise blood sugar levels.

It’s essential for patients to discuss these potential risks with their healthcare provider before undergoing a genicular block procedure. Overall, the benefits of pain relief often outweigh the risks for many patients with chronic knee pain.

 

If a genicular block does not provide the desired pain relief, there are several possible next steps:

  1. Reevaluation: The physician may reevaluate the patient to ensure that the diagnosis is accurate and that there are no other contributing factors to the knee pain.

  2. Alternative treatments: Depending on the specific circumstances, the physician may recommend alternative treatments such as physical therapy, bracing, acupuncture, or other interventions.

  3. Repeat procedure: Sometimes, a genicular block may not provide immediate or complete relief, but it may still be beneficial when repeated. The physician may suggest a repeat procedure, possibly with adjustments in technique or medication dosage.

  4. Different type of nerve block: If the genicular block is ineffective, the physician may consider other types of nerve blocks targeting different nerves or areas around the knee joint.

  5. Surgical options: If conservative treatments, including nerve blocks, have failed to provide relief, the patient and physician may discuss surgical options such as knee replacement, arthroscopy, or other procedures to address the underlying cause of the pain.

  6. Pain management strategies: In cases of chronic, refractory pain, a multidisciplinary approach to pain management may be necessary. This could involve working with a pain management specialist, physiatrist, or other healthcare professionals to develop a comprehensive treatment plan.

It’s essential for patients to communicate openly with their healthcare provider about their pain levels and treatment outcomes to explore the most appropriate options for managing their knee pain effectively.

After a genicular block procedure, it’s essential to follow any specific instructions provided by your healthcare provider. While there may be variations in recommendations based on individual circumstances and the specific approach used in the procedure, here are some general guidelines on activities to avoid or limitations to consider:

  1. Driving: It’s typically advised to avoid driving immediately after the procedure, as the injected anesthetic may temporarily affect coordination and reaction times. Arrange for someone else to drive you home if possible.

  2. Heavy lifting: Avoid lifting heavy objects or engaging in strenuous activities for at least 24 hours following the procedure. This helps minimize the risk of bleeding or aggravating the injection site.

  3. Strenuous exercise: While light activities such as walking are usually encouraged to prevent stiffness and promote circulation, avoid intense exercise or activities that put significant strain on the knee joint for a few days after the procedure.

  4. Soaking in water: Avoid soaking the injection site in water, such as swimming or taking baths, for at least 24 hours after the procedure to reduce the risk of infection.

  5. Alcohol consumption: It’s generally recommended to avoid alcohol for at least 24 hours after the procedure, as it can interact with the medications used and may increase the risk of bleeding or other complications.

  6. Skipping follow-up appointments: Attend any scheduled follow-up appointments with your healthcare provider to monitor your response to the procedure and address any concerns or questions you may have.

Always consult your healthcare provider for personalized advice on post-procedure care and activity restrictions based on your individual circumstances and medical history.