scholarly journals FRI0382 EFFECTS OF GENICULAR NERVE BLOCK IN PATIENTS WITH KNEE OSTEOARTHRITIS WHO HAVE NEUROPATHIC OR NOCICEPTIVE PAIN

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 788.2-789
Author(s):  
B. Tas ◽  
P. Akpinar ◽  
I. Aktas ◽  
F. Unlu Ozkan ◽  
I. B. Kurucu
Keyword(s):  
Neuropathic Pain ◽  
Knee Osteoarthritis ◽  
Nerve Block ◽  
Intractable Pain ◽  
Ultrasound Guided ◽  
Lidocaine Group ◽  
Knee Oa ◽  
Significant Difference ◽  
Genicular Artery ◽  
Saline Solutions

Background:Genicular nerve block (GNB) is a safe and effective therapeutic procedure for intractable pain associated with chronic knee osteoarthritis (OA)(1). There is increasing support for the neuropathic component to the knee OA pain. Investigators proposed that targeting treatment to the underlying pain mechanism can improve pain management in knee OA (2). There is a debate on injectable solutions used in nerve blocks (3).Objectives:To investigate the analgesic and functional effects of USG-guided GNB in patients with chronic knee OA (with/without neuropathic pain) and to evaluate the efficacy of the anesthetic and non-anesthetic solutions used.Methods:Ninety patients with chronic knee OA between the ages of 50-80 were divided into two groups with and without neuropathic pain according to painDETECT questionnaire (4). The groups were randomized into three subgroups to either the lidocaine group (n=30) or dextrose group (n=29) or saline solutions (n=31). After the ultrasound-guided GNB, quadriceps isometric strengthening exercises and cryotherapy were recommended to the patients. Visual analog scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Lequesne-algofunctional Index were assessed at baseline and at 1 week, 1 and 3 months later after the procedure.Results:Statistically significant improvement was observed in all groups with or without neuropathic pain according to VAS values at the 1stweek, 1stmonth and 3rdmonth compared to baseline (p<0.05). Statistically significant improvement was observed in all groups with neuropathic pain according to painDETECT values at the 1stweek, 1stmonth and 3rdmonth compared to baseline (p<0.05). There was a statistically significant improvement in the groups without neuropathic pain which received dextrose and saline solutions, according to painDETECT values, but not in the group which received lidocain at the 1stweek, 1stmonth and 3rdmonth compared to baseline (p>0.05). There was a statistically significant improvement in all groups with or without neuropathic pain according to WOMAC and Lequesne total scores at the 1stweek, 1stmonth and 3rdmonth compared to baseline (p<0.05).Conclusion:We conclude that in patients with chronic knee OA (with/without neuropathic pain), the use of GNB with USG is an analgesic method which provides short to medium term analgesia and functional recovery and has no serious side effects. The lack of significant difference between the anesthetic and non-anesthetic solutions used in the GNB suggests that this may be a central effect rather than a symptom of peripheral nerve dysfunction. It suggests that injection may have an indirect effect through nociceptive processing and changes in neuroplastic mechanisms in the brain. In addition, we can say that regular exercise program contributes to improved physical function with the decrease in pain.References:[1]Kim DH et al. Ultrasound-guided genicular nerve block for knee osteoarthritis: a double-blind, randomized controlled trial of local anesthetic alone or in combination with corticosteroid. Pain Physician 2018;21:41-51.[2]Thakur M et.al. Osteoarthritis pain: nociceptive or neuropathic?. Nat Rev Rheumatol 2014:10(6):374.[3]Lam SKH et al. Transition from deep regional blocks toward deep nerve hydrodissection in the upper body and torso: method description and results from a retrospective chart review. BioMed Research International Volume 2017;7920438.[4]Hochman JR et al. Neuropathic pain symptoms in a community knee OA cohort. Osteoarthritis Cartilage. 2011 Jun;19(6):647-54.Fig. 1:Ultrasound- guided identification of GNB target sites. Doppler mode. White arrows indicate genicular arteries.A.Superior medial genicular artery.B.Inferior medial genicular artery.C.Superior lateral genicular artery.Disclosure of Interests:None declared

scholarly journals Intra-articular corticosteroid injection and genicular nerve block under ultrasound guidance in pain control of knee osteoarthritis

2021 ◽  
Vol 52 (1) ◽  
Author(s):  
Abdel Rahman Ragab ◽  
Sherif Hegab ◽  
Rehab Elnemr ◽  
Amr Abdel-Kerim
Keyword(s):  
Knee Osteoarthritis ◽  
Nerve Block ◽  
Corticosteroid Injection ◽  
Oxford Knee Score ◽  
The Elderly ◽  
Functional Improvement ◽  
Ultrasound Guided ◽  
Knee Oa ◽  
Group 2

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. The current study aimed to investigate the efficacy of those two approaches when guided with ultrasound and to determine which one offers better results. This study included 40 patients with painful chronic knee OA (Nine males and 31 females, age ranged from 44 to 65 years) and were randomly assigned to two equal groups. Groups 1 was managed with ultrasound-guided IACSI and group 2 with ultrasound-guided GNB using a mixture of lidocaine and Triamcinolone Acetonide. The baseline mean visual analogue scale (VAS) and Oxford knee score (OKS) for the group 1 were 87.10 and 51.3, while for group 2 were 87.75 and 53.25 respectively. Follow up values were obtained at 2, 4 and 8 weeks using VAS and OKS. Results The VAS score and OKS score were significantly lower in the GNB group and IACSI group at 2, and 4 weeks after the procedure (p < 0.001 for all), then returned near baseline values at 8 weeks. When the two groups were compared according to changes in VAS and OKS from baseline at 2, 4, and 8 weeks, GNB group showed significant alleviation of pain (mean reduction of 58.5, 53.3, and 9.25 points at 2, 4, and 8 weeks versus 44.9, 39.4, and 5.6 points at the IACSI groups, p < 0.001 at 2 and 4 weeks, p < 0.006 at 8 weeks). Similarly at the OKS, the GNB group showed significantly better results (33.50, 28.60, and 8.5 at GNB and 26.45, 20.10, 5.25 at IACSI. p < 0.001 at all periods). Conclusions Both GNB and IACSI are effective methods to relieve chronic knee osteoarthritis-related pains. When compared to each other, GNB showed more significant pain relief and functional improvement than IACSI.

scholarly journals Ultrasound-Guided Genicular Nerve Block for Knee Osteoarthritis: A Double-Blind, Randomized Controlled Trial of Local Anesthetic Alone or in Combination with Corticosteroid

2018 ◽  
Vol 1 (21;1) ◽  
pp. 41-51 ◽  
Author(s):  
Woo-Jong Choi
Keyword(s):  
Knee Osteoarthritis ◽  
Nerve Block ◽  
Local Anesthetic ◽  
Oxford Knee Score ◽  
Rf Ablation ◽  
Ultrasound Guided ◽  
Analog Scale ◽  
Short Term ◽  
Knee Oa

Background: Recently, several studies suggested that radiofrequency (RF) ablation of the genicular nerves is a safe and effective therapeutic procedure for intractable pain associated with chronic knee osteoarthritis (OA). 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. Objectives: The current study aims to assess the effects of combining corticosteroids and local anesthesia during ultrasound-guided GNB in patients with chronic knee OA. Study Design: A randomized, double-blinded institutional study. Setting: This study took place at Asan Medical Center in Seoul, Korea. Methods: Forty-eight patients with chronic knee OA were randomly assigned to either the lidocaine alone group (n = 24) or lidocaine plus triamcinolone (TA) group (n = 24) before ultrasound-guided GNB. Visual analog scale (VAS), Oxford Knee Score (OKS), and global perceived effects (7-point scale) were assessed at baseline and at 1, 2, 4, and 8 weeks after the procedure. Results: The VAS scores were significantly lower in the lidocaine plus TA group than in the lidocaine alone group at both 2 (P < 0.001) and 4 (P < 0.001) weeks after GNB. The alleviation of intense pain in the lidocaine plus TA group was sustained up to 2 weeks after the procedure, in accordance with the definition of a minimal clinically important improvement. Although a similar intergroup difference in OKSs was observed at 4 weeks (P < 0.001), the clinical improvement in functional capacity lasted for only one week after the reassessment of OKSs, in accordance with a minimal important change. No patient reported any postprocedural adverse events during the follow-up period. Limitations: The emotional state of the patients, which might affect the perception of knee pain, was not evaluated. The follow-up period was 2 months; this period might be insufficient to validate the short-term effects of GNB. Conclusions: Ultrasound-guided GNB, when combined with a local anesthetic and corticosteroid, can provide short-term pain relief. However, the clinical benefit of corticosteroid administration was not clear in comparison with local anesthesia alone. Given the potential adverse effects, corticosteroids might not be appropriate as adjuvants during a GNB for chronic knee OA. The study protocol was approved by our institutional review board (2012-0210), and written informed consent was obtained from all patients. The trial was registered with the Clinical Research Information Service (KCT 0001139). Key words: Chronic pain, knee osteoarthritis, genicular nerve block, ultrasound, corticosteroid, local anesthetic, visual analog scale, Oxford Knee Score

scholarly journals Increasing Intrinsic Hyaluronic Acid and Down-regulation of Inflammation Markers in Synovial Fluid from Patients with Knee Osteoarthritis may be Associated with Symptom Relief after Intra-articular Injection of Hyaluronic Acid

2021 ◽  
Author(s):  
Jih-Hsi Yeh ◽  
Po-Yen Ko ◽  
Chung-Jung Shao ◽  
Kuo-Chen Wu ◽  
Tai-Chang Chern ◽  
...  
Keyword(s):  
Hyaluronic Acid ◽  
Synovial Fluid ◽  
Knee Osteoarthritis ◽  
Symptom Relief ◽  
Functional Improvement ◽  
Ultrasound Guided ◽  
Analog Scale ◽  
Knee Oa ◽  
Significant Difference ◽  
Womac Questionnaire

Abstract Background: Hyaluronic acid (HA) is the most common intra-articular therapy used to treat mild to moderate osteoarthritis (OA). However, the mechanism involved in this treatment is still not fully understood. The aim of the present study was to examine the effect and the possible mechanism of intra-articular HA (IAHA) injection in patients with knee osteoarthritis (OA).Methods: Twenty-eight patients with Kellgren–Lawrence scale II to III were enrolled in this study. All patients underwent ultrasound-guided injection using three consecutive weekly IAHA. Functional ability and pain were determined by the Western Ontario and McMaster University Index (WOMAC) questionnaire and visual analog scale (VAS). Further, the levels of HA, metalloproteinase (MMP)-1, MMP-3, MMP-13, interleukin (IL)-1β and IL-6 in synovial fluid were determined weekly before HA injection. Results: Functional improvement and pain relief were observed 4 weeks after treatment. At week 4, a significant increase of HA concentration was found, and the concentration of inflammatory cytokines including IL-1β, and IL-6, as well as matrix MMP-3 and MMP-13 significantly decreased. However, no significant difference was observed in MMP-1 level. Conclusion: These results suggest that increasing HA accumulation in synovial fluid may be associated with disease relief after weekly IAHA injection in patients with knee OA.

scholarly journals A Positive Association Between Foot Posture Index and Medial Compartment Knee Osteoarthritis in Moroccan People

2014 ◽  
Vol 8 (1) ◽  
pp. 96-99 ◽  
Author(s):  
Abourazzak F.E ◽  
Kadi N ◽  
Azzouzi H ◽  
Lazrak F ◽  
Najdi A ◽  
...  
Keyword(s):  
Knee Osteoarthritis ◽  
Medial Compartment ◽  
Control Group ◽  
Flat Foot ◽  
Pes Cavus ◽  
Foot Posture Index ◽  
Posture Index ◽  
Knee Oa ◽  
Significant Difference ◽  
Foot Posture

Objectives : To compare foot posture in people with and without medial compartment knee osteoarthritis (OA), and to assess association between its abnormalities and medial compartment knee OA. Methods : We compared the foot posture of patients with clinically and radiographically-confirmed medial compartment knee OA and asymptomatic healthy controls using the foot posture index (FPI), navicular height, and the medial arch. Results : We included 100 patients and 80 asymptomatic controls. The mean age of patients was 59 ± 7 (44-76) years and 48 ± 9 (28-60) years in the control (p=0.06). Patients group have more pronated foot for FPI (1.50 ± 2.68 vs 0.72 ± 2.63; p=0.05), more flat foot (42% vs 22%; p=0.03), and less pes cavus than the control group (58% vs 77%; p=0.004). However, there was no significant difference between the groups in the navicular height (3.90 ± 0.85 cm vs 4.00 ± 0.76 cm; p=0.41). In multivariate statistical analysis, after adjusting for age and body mass index, pronated foot in FPI (OR=1.22, 95%IC= [1.06-1.40], p=0.005), and pes cavus (OR=0.32, 95%IC= [0.11-0.93], p=0.03) had a significant correlation with the knee osteoarthritis. Conclusion : Pronated foot posture and flat foot are significantly associated with medial compartment knee osteoarthritis.

Pain management in patients with knee osteoarthritis by ultrasound-guided genicular nerve block. Case reports

2020 ◽  
Vol 3 (3) ◽  
Author(s):  
Thiago Alves Rodrigues ◽  
Eduardo José Silva Gomes de Oliveira ◽  
João Batista Santos Garcia
Keyword(s):  
Pain Management ◽  
Knee Osteoarthritis ◽  
Nerve Block ◽  
Case Reports ◽  
Ultrasound Guided

scholarly journals Comparison Of Diacerein-Ginger With Diacerein Alone In Treating Knee Osteoarthritis

2019 ◽  
Vol 09 (04) ◽  
pp. 308-311
Author(s):  
Mehtab Munir ◽  
Shahid Mustafa Memon ◽  
Sajid Abbas Jaffri ◽  
Khalid Mustafa Memon
Keyword(s):  
Knee Osteoarthritis ◽  
P Value ◽  
Womac Pain ◽  
Test Results ◽  
Knee Oa ◽  
Significant Difference ◽  
Group A ◽  
Insignificant Difference ◽  
Group B ◽  
Pain At Rest

Objective: To compare clinical efficacy of diacerein-ginger with diacerein alone in treating knee osteoarthritis. Duration and place of study: It was a randomized clinical trial conducted from 21st September 2018 to 31stMarch 2019, in medical OPD of a private hospital in Karachi. Methodology: 60 diagnosed patients of knee osteoarthritis were included in this study. Male and female patients 50 years of age, fulfilling the inclusion criteria and after written informed consent experienced a wash-out period of 72 hours. These patients were systematically randomized into 2 groups each having 30 members. Group A received capsule Diacerein 50mg + capsule Ginger 550 mg twice daily and group B received capsule Diacerein 50mg twice daily, for 12 weeks. Parameters checked at 0, 6 and 12 weeks were: Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index, pain at rest and movement (Visual Analogue Scale). Comparison of the two groups was done by independent t-test. Results: Among 60 patients; 20 (33.33 %) were males and 40 (66.66%) were females. 4 patients in group A and 4 in B, dropped out during the study. Comparison of group A with group B in WOMAC and pain (at rest and movement) scores showed insignificant difference at day 0 before prescription of the drugs. However comparison showed highly significant difference (P-value < 0.001) between the two groups in WOMAC, pain at rest and movement scores at the end of 6th and 12th weeks of intervention. Conclusion: Diacerein-Ginger is clinically more efficacious for management of knee OA than Diacerein alone

scholarly journals Laser Needling® and Natural origin, Highly Purifi ed Polynucleotides (PN-HPT™) in Knee Osteoarthrosis: Benefi ts in Physiatry and Sports Medicine

2020 ◽  
Vol 4 (2) ◽  
pp. 030-037
Author(s):  
Maria Conforti
Keyword(s):  
Knee Osteoarthritis ◽  
Real Life ◽  
Treatment Protocol ◽  
Low Energy ◽  
Ultrasound Guided ◽  
Laser Technique ◽  
Laser Device ◽  
Short Term ◽  
Natural Origin ◽  
Knee Oa

Background and Objectives: The purpose of the paper is to illustrate the real life clinical outcomes of a retrospective cohort of knee Osteoarthritis (OA) patients treated with a novel laser disease management program; at the same time, to defi ne the most effective operative procedure. The new laser technique mimics the in-vitro benefi ts of Low-Level Laser Therapies (LLLT). The study compared the 3month effi cacy and 6-month persistence of clinical and functional benefi ts after application of laser energy either externally with a standard High Power Laser Therapy (HPLT) laser device (AG1 device, FP3 version), or intra-articularly with the patented, low-energy AG8 intra articular fi ber device (ultrasound-guided, same wavelengths, no handpiece). This innovative laser device reduces to one hundredth the applied energy density. The pain suppressing effi cacy of the LLLT-like laser FP3 procedure is intended to act synergically with the strong biorestructuring and pain suppressing effi cacy of natural origin polynucleotides (PN-HPT™ or Highly Purifi ed Technology™) injected before the laser session. PN-HPT™ are widely used in knee OA management for their persistent viscosupplementation properties overlapping those of high molecular weight hyaluronic acid. Trial design: retrospective comparison of:  Short term 3 month effi cacy outcomes on pain and disability  6-month persistence of clinical improvements in two cohorts of patients with severe knee osteoarthritis. The active cohort knee OA patients (105 agonistic or recreative practitioners with persistent knee pain and disability resistant to conventional medical or physical therapies) were treated with an innovative intra articular low-energy AG8 physical therapy protocol (ambulatory “AG8 Protocol 3” combined with a preliminary PN-HPT™ knee injection); the control-cohort patients (109 patients with knee disease of similar severity) were treated with a standard, multi frequency HPLT ambulatory treatment protocol (FP3 device). Outcome parameters: Western Ontario and McMaster Universities (WOMAC) assessments at baseline (T0) and after 2 weeks (T2) and 3 months (T3). Secondary parameters: Nociceptive and neuropathic pain; assessment: standard 10 cm Visual Analogue Scale (VAS) immediately before and at the end of each treatment session. Results: Treatment with the AG8 protocol 3 / PN-HPT™ intra articular combination was associated with strongly signifi cant short term (2 weeks) and medium-term (3 months) benefi ts vs. controls treated with a conventional FP3 extra-articular treatment protocol both for the WOMAC Total Score and WOMAC Pain and Function subscores. Benefi ts for the WOMAC Stiffness subscore were borderline non-signifi cant. The subgroup analysis showed that the 2A (Grade-2 KL primary OA) and 2B (Grade-2 KL secondary (post-surgical) OA) mainly contributed to overall benefi ts. Conclusion: The study showed the intra-articular Laser Needling® technique (ultrasound-guided AG8 laser device, Protocol 3 plus infi ltration of a facilitating agent such as intra-articular PN-HPT™ gel) to be more effective on knee OA pain than the traditional extra-articular FP3 laser technique, with special reference to pain associated with primary OA.

scholarly journals Intra-Articular Hybrid Hyaluronic Acid Injection Treatment in Overweight Patients with Knee Osteoarthritis: A Single-Center, Open-Label, Prospective Study

2021 ◽  
Vol 11 (18) ◽  
pp. 8711
Author(s):  
Dalila Scaturro ◽  
Fabio Vitagliani ◽  
Pietro Terrana ◽  
Daniele Cuntrera ◽  
Vincenzo Falco ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Hyaluronic Acid ◽  
Knee Osteoarthritis ◽  
Disease Severity ◽  
Prospective Trial ◽  
Open Label ◽  
Knee Oa ◽  
Symptomatic Knee ◽  
Significant Difference

Background: A BMI > 25 is the most decisive, albeit modifiable, risk factor for knee osteoarthritis (KOA). This study aimed at assessing the efficacy of intra-articular injections of hybrid hyaluronic acid (HA) complexes (Sinovial® H-L) for the treatment of KOA in overweight patients in terms of disease severity, cardiocirculatory capacity, and quality of life. Materials: In this single-site, open-label, prospective trial, 37 patients with symptomatic knee OA were assessed at baseline and 3 months after ultrasound-guided intra-articular injection of hybrid HA complexes (Sinovial® H-L). Results: Primary variables displaying a statistically significant improvement after treatment were pain (VAS), disease severity (WOMAC), and cardiopulmonary capacity (6 min walk test). Among secondary variables, quality of life (SF-12) improved significantly, as did analgesic intake for pain control. No statistically significant difference was observed in body fat and muscle mass percentage measured by bioelectrical impedance analysis. Conclusions: Intra-articular hybrid HA injections are significantly effective in improving OA-related disease severity, cardiopulmonary function, and analgesic intake. This supports the role of hybrid HA viscosupplementation as a nonpharmacological treatment to relieve pain, reduce disability, improve quality of life, and limit the risk of polypharmacy in overweight patients with knee OA.

scholarly journals Lower Limb Muscle Strength and Muscle Mass Are Associated With Incident Symptomatic Knee Osteoarthritis: A Longitudinal Cohort Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Nicola Veronese ◽  
Sinisa Stefanac ◽  
Ai Koyanagi ◽  
Nasser M. Al-Daghri ◽  
Shaun Sabico ◽  
...  
Keyword(s):  
Knee Osteoarthritis ◽  
Muscle Mass ◽  
Lower Limbs ◽  
American People ◽  
Knee Oa ◽  
Skeletal Mass ◽  
Symptomatic Knee Osteoarthritis ◽  
Symptomatic Knee ◽  
Significant Difference

Recent literature suggests that sarcopenia, often represented by low lower limbs muscle mass and strength, can be considered a potential risk factor for knee osteoarthritis (OA), but the available literature is still limited. We therefore aimed to investigate whether sarcopenia is associated with a higher risk of radiographic (ROA) and symptomatic knee OA (SxOA) in a large cohort of North American people in the context of the OA initiative. Sarcopenia at baseline was diagnosed in case of low skeletal muscle mass (i.e., lower skeletal mass index) and poor performance in the chair stands test. The outcomes of interest for this study included ROA (radiographical osteoarthritis) if a knee developed a Kellgren and Lawrence (KL) grade ≥2 at follow-up, and SxOA (symptomatic osteoarthritis) defined as new onset of a combination of painful knee OA. Altogether, 2,492 older participants (mean age: 68.4 years, 61.4% females) were included. At baseline, sarcopenia was present in 6.1% of the population. No significant difference in ROA prevalence was observed between those with and without sarcopenia (p=0.76), whilst people with sarcopenia reported a significant higher prevalence of SxOA (p&lt;0.0001). Using a logistic regression analysis, adjusting for potential confounders at baseline and the diagnosis of sarcopenia during follow-up, sarcopenia was associated with a higher incidence of knee SxOA (odds ratio, OR=2.29; 95%CI [confidence interval]: 1.42-3.71; p=0.001), but not knee ROA (OR=1.48; 95%CI: 0.53-4.10; p=0.45). In conclusion, sarcopenia could be associated with a higher risk of negative knee OA outcomes, in particular symptomatic forms.

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