Comparison of Genicular Nerve Block in Combination With Adductor Canal Block in Both Primary and Revision Total Knee Arthroplasty: A Retrospective Case Series

Promil Kukreja, Alana Venter, Lauren Mason, Alexander M Kofskey, Theresa Northern, Sameer Naranje, Elie Ghanem, Prentiss A Lawson, Hari Kalagara, Promil Kukreja, Alana Venter, Lauren Mason, Alexander M Kofskey, Theresa Northern, Sameer Naranje, Elie Ghanem, Prentiss A Lawson, Hari Kalagara

Abstract

The management of pain in patients undergoing total knee arthroplasty (TKA) for chronic knee osteoarthritis (OA) has remained a challenge for the anesthesiologist regarding regional anesthesia as no single regional technique is adequate with regard to balancing effective analgesia with minimal muscle weakness. Severe postoperative pain following TKA has been shown to negatively impact patient outcomes and mortality. The genicular nerve block has recently been demonstrated to provide effective analgesia to the anterior and posterior knee capsule in recent studies. In this retrospective case series, we compare the efficacy of combined genicular nerve block (GNB) and adductor canal block (ACB) to only ACB in both primary and revision TKA patients. This combined novel approach for TKA patients can be utilized to improve patient pain scores and early ambulation, limiting the use of opioids and early discharge.

Keywords: adductor canal block; genicular nerve block; oral morphine equivalents; post-operative analgesia; total knee arthroplasty.

Conflict of interest statement

The authors have declared that no competing interests exist.

Copyright © 2021, Kukreja et al.

Figures

Figure 1. Probe positioning for superomedial genicular…
Figure 1. Probe positioning for superomedial genicular block
The patient is in supine position with a linear probe placed along the longitudinal plane for femur.
Figure 2. Superomedial genicular block anatomy
Figure 2. Superomedial genicular block anatomy
To target the genicular nerve at this site, the genicular artery is used as a landmark along the distal femur.
Figure 3. Superomedial genicular block with in-plane…
Figure 3. Superomedial genicular block with in-plane needle visualization
Local anesthesia is injected along the periosteum near the genicular artery.
Figure 4. Inferomedial genicular block ultrasound anatomy
Figure 4. Inferomedial genicular block ultrasound anatomy
Local anesthesia is ideally injected near the genicular artery (landmark) at the junction of medial condyle of tibia and tibial shaft.
Figure 5. OME for ACB plus genicular…
Figure 5. OME for ACB plus genicular blocks for primary TKA in postoperative period
OME, Oral morphine equivalents; ACB, adductor canal block; TKA, total knee arthroplasty.
Figure 6. OME for ACB plus genicular…
Figure 6. OME for ACB plus genicular blocks for revision TKA in postoperative period
OME, Oral morphine equivalents; ACB, adductor canal block; TKA, total knee arthroplasty.
Figure 7. Ambulation distance for all procedures…
Figure 7. Ambulation distance for all procedures (primary and revision) with ACB and genicular blocks
ACB, Adductor canal block.

References

    1. Knee osteoarthritis has doubled in prevalence since the mid-20th century. Wallace IJ, Worthington S, Felson DT, et al. Proc Natl Acad Sci U S A. 2017;114:9332–9336.
    1. Is cooled radiofrequency genicular nerve block and ablation a viable option for the treatment of knee osteoarthritis? Carlone AG, Grothaus O, Jacobs C, Duncan ST. Arthroplast Today. 2021;7:220–224.
    1. Evaluation of the iPACK block injectate spread: a cadaveric study. Tran J, Giron Arango L, Peng P, Sinha SK, Agur A, Chan V. Reg Anesth Pain Med. 2019
    1. Estimating the burden of total knee replacement in the United States. Weinstein AM, Rome BN, Reichmann WM, et al. J Bone Joint Surg Am. 2013;95:385–392.
    1. Ultrasound-guided local anesthetic infiltration between the popliteal artery and the capsule of the posterior knee (IPACK) block for primary total knee arthroplasty: a systematic review of randomized controlled trials. D'Souza RS, Langford BJ, Olsen DA, Johnson RL. Local Reg Anesth. 2021;14:85–98.
    1. The impact of painful knee osteoarthritis on mortality: a community-based cohort study with over 24 years of follow-up. Cleveland RJ, Alvarez C, Schwartz TA, Losina E, Renner JB, Jordan JM, Callahan LF. Osteoarthritis Cartilage. 2019;27:593–602.
    1. Chronic pain following total hip arthroplasty: a nationwide questionnaire study. Nikolajsen L, Brandsborg B, Lucht U, Jensen TS, Kehlet H. Acta Anaesthesiol Scand. 2006;50:495–500.
    1. Guidelines for the management of postoperative pain after total knee arthroplasty. Korean Knee Society. Knee Surg Relat Res. 2012;24:201–207.
    1. Infiltration between the popliteal artery and the capsule of the knee (IPACK) block in knee surgery: a narrative review [IN PRESS] Chan E, Howle R, Onwochei D, Desai N. Reg Anesth Pain Med. 2021
    1. Addition of infiltration between the popliteal artery and the capsule of the posterior knee and adductor canal block to periarticular injection enhances postoperative pain control in total knee arthroplasty: a randomized controlled trial. Kim DH, Beathe JC, Lin Y, et al. Anesth Analg. 2019;129:526–535.
    1. Comparison of adductor canal block and IPACK block (interspace between the popliteal artery and the capsule of the posterior knee) with adductor canal block alone after total knee arthroplasty: a prospective control trial on pain and knee function in immediate postoperative period. Sankineani SR, Reddy AR, Eachempati KK, Jangale A, Gurava Reddy AV. Eur J Orthop Surg Traumatol. 2018;28:1391–1395.
    1. The effect of the IPACK block on pain after primary TKA: a double-blinded, prospective, randomized trial. Patterson ME, Vitter J, Bland K, Nossaman BD, Thomas LC, Chimento GF. J Arthroplasty. 2020;35:0–7.
    1. Ultrasound-guided genicular nerve block for pain control after total knee replacement: Preliminary case series and technical note. Sotelo VG, Maculé F, Minguell J, Bergé R, Franco C, Sala-Blanch X. Rev Esp Anestesiol Reanim. 2017;64:568–576.
    1. Local infiltration analgesia in joint replacement: the evidence and recommendations for clinical practice. Kehlet H, Andersen LØ. Acta Anaesthesiol Scand. 2011;55:778–784.
    1. Accuracy of ultrasound-guided genicular nerve block: a cadaveric study. Yasar E, Kesikburun S, Kılıç C, Güzelküçük Ü, Yazar F, Tan AK. Pain Physician. 2015;18:0–904.
    1. Radiofrequency treatment relieves chronic knee osteoarthritis pain: a double-blind randomized controlled trial. Choi WJ, Hwang SJ, Song JG, Leem JG, Kang YU, Park PH, Shin JW. Pain. 2011;152:481–487.
    1. Distribution of sensory nerves supplying the knee joint capsule and implications for genicular blockade and radiofrequency ablation: an anatomical study. Fonkoué L, Behets C, Kouassi JK, Coyette M, Detrembleur C, Thienpont E, Cornu O. Surg Radiol Anat. 2019;41:1461–1471.
    1. Genicular nerve block for postoperative pain relief after total knee replacement. Sahoo RK, Krishna C, Kumar M, Nair AS. Saudi J Anaesth. 2020;14:235–237.
    1. Innervation of the Anterior Capsule of the Human Knee: Implications for Radiofrequency Ablation. Franco CD, Buvanendran A, Petersohn JD, Menzies RD, Menzies LP. Reg Anesth Pain Med. 2015;40:363–368.
    1. Anatomic and ultrasonographic evaluation of the knee sensory innervation: a cadaveric study to determine anatomic targets in the treatment of chronic knee pain. Orduña Valls JM, Vallejo R, López Pais P, et al. Reg Anesth Pain Med. 2017;42:90–98.
    1. Motor-sparing knee block - description of a new technique. Egeler C, Jayakumar A, Ford S. Anaesthesia. 2013;68:542–543.
    1. The clinical case report: a review of its merits and limitations. Nissen T, Wynn R. BMC Res Notes. 2014;7:264.

Source: PubMed

Sponsorer och medarbetare

Medicinska tillstånd

Läkemedelsinterventioner

3
Prenumerera