Effectiveness of genicular nerve block on pain and disability in chronic knee osteoarthritis: a randomized double...

This study aimed to evaluate whether ultrasound-guided genicular nerve block (GNB) provides superior pain relief and functional improvement in patients with knee osteoarthritis (OA) compared to a placebo procedure. Additionally, it investigated whether the inclusion of a corticosteroid enhances the efficacy of the block.

Eighty-one patients diagnosed with knee OA according to the American College of Rheumatology criteria were enrolled in this prospective, randomized, double-blind, placebo-controlled study. Participants were randomly assigned to one of three groups: GNB with local anesthetic (group 1), GNB with local anesthetic plus corticosteroid (group 2), or a placebo procedure (group 3). All patients followed a standardized daily knee exercise program. Primary outcome measure was pain severity evaluated by the Visual Analog Scale (VAS) and pressure pain threshold (PPT) measured with an algometer, secondary outcome measure was disability and function level evaluated by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the 40-m fast-paced walk test. Assessments were conducted at baseline, as well as at the 1st week and 1st month following the intervention.

A total of 75 patients completed the study. All three groups demonstrated statistically significant improvements in VAS scores at both the 1st week (p-values for groups 1, 2, and 3: < 0.0001, < 0.0001, and 0.039, respectively) and the 1st month (p-values: 0.001, < 0.001, and 0.007, respectively) compared to baseline. Both treatment groups showed significantly greater improvements than the placebo group at both follow-up points (p = 0.001). Significant improvements in medial patella PPT, WOMAC scores, and the 40-m fast-paced walk test were observed in groups 1 and 2 (p < 0.05), but not in group 3. No statistically significant differences were found between groups 1 and 2 for any of the outcome measures (p > 0.05).

In patients with knee OA, GNB leads to reduced pain and disability and improved physical capacity, regardless of whether corticosteroids are used as an adjuvant. Key Points • Ultrasound-guided genicular nerve block appears to be an effective treatment option for reducing pain and improving function in patients with knee osteoarthritis. • Adding corticosteroids to the local anesthetic during the procedure did not provide any additional benefit in terms of pain relief or functional improvement.