ULTRASOUND-GUIDED GENICULAR NERVE BLOCK WITH LOCAL ANAESTHETIC AND CORTICOSTEROID FOR PAIN RELIEF IN KNEE OSTEOARTHRITIS AT A TERTIARY CARE HOSPITAL IN KASHMIR VALLEY.

Abstract

Background: Chronic knee osteoarthritis (OA) is a frequent disease among the elderly. Intra-articular corticosteroid injection (IACSI) was commonly adopted to alleviate knee OA-related pains. Recently, Genicular nerve block (GNB) has emerged as a new alternative technique. Diagnostic genicular nerve block (GNB) with local anesthetic has been generally conducted before making decisions regarding RF ablation. Although GNB has been recently performed together with corticosteroid, the analgesic effects of corticosteroids for treating chronic pain remain controversial.  Aim: To assess the effects of corticosteroids and local anesthesia during ultrasound-guided GNB in patients with chronic knee OA. 

Methods: A profile of 30 Patients of knee osteoarthritis of moderate or higher grade, not responding to conservative treatment of physiotherapy and anti inflammatory drugs, were enrolled for the study. Patients having blood coagulopathies, unfit medical conditions, and local and systemic infections, Kellgren-Lawrence (KL) grade I were excluded.

Results: 15 patients (50%) had KL classification grade II knee osteoarthritis, while 11 patients (36.6%) had KL grade III and 4 patients (13.3%) had KL grade IV knee osteoarthritis among the study population. Mean OKS scores before treatment to OKS score at 24 hours showed very highly significant difference (p=0.0000) while scores remained similar at 4 and 12 weeks.

Conclusion: Ultrasound guided genicular nerve block using corticosteroid injection for knee osteoarthritis seems to be effective in decreasing pain and improving functional outcome in patients with severe osteoarthritis. However, further studies with larger sample size and longer duration of follow up are required to draw robust conclusions.