GENICULAR NERVE ABLATION WITH PHENOL TO TREAT CHRONIC KNEE PAIN
SHAHEEN MAGSI M.D., NEIL ANAND M.D.
INSTITUTE OF ADVANCED MEDICINE AND SURGERY
Chronic knee pain is often poorly managed with conservative treatment. A new technique of radiofrequency ablation (RFA) of the genicular nerve has been introduced as an exciting novel therapeutic alternative. Unfortunately, widespread adoption of RFA of the genicular nerves is hampered by the requirement of an expensive radiofrequency generator, the significant cost of sedation anesthesia, and use of surgical operating room. A cost efficient and therapeutically superior method using phenol has been investigated.
To determine the therapeutic effectiveness of ablating genicular nerves using phenol in treating chronic knee pain associated with osteoarthritis or trauma, and in restoring overall knee function.
This study involved 46 patients diagnosed with chronic knee pain with minimal to no relief from conservative treatments. The 46 patients included 21 female patients and 25 male patients.
• The first stage consisted of a diagnostic genicular nerve block with ultrasound guidance using lidocaine or bupivacaine.
• In the second stage all patients proceeded to receive phenol ablation (mixture of lidocaine 2% and phenol 6%) if they had a greater than 50% positive response to the diagnostic nerve block.
The three main genicular nerves (superior medial, inferior medial, and superior lateral branches) were chemically ablated using phenol under ultrasound guidance. One nerve branch was ablated at one time, with 2 week intervals between each ablation. The whole ablation process was completed within 4 weeks, resulting in pain relief for an average of 5 months.