Doo-Hwan Kim1, Seong-Soo Choi2, Syn-Hae Yoon1, So-Hee Lee1, Dong-Kyun Seo1, In-Gyu Lee1, Woo-Jong Choi1, Jin-Woo Shin2. 1. Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea. 2. Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Abstract
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.
RCT Entities:
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.
Authors: Antonia F Chen; Fred Khalouf; Keith Zora; Michael DePalma; Lynn Kohan; Maged Guirguis; Douglas Beall; Eric Loudermilk; Matthew J Pingree; Ignacio Badiola; Jeffrey Lyman Journal: BMC Musculoskelet Disord Date: 2020-06-09 Impact factor: 2.362