Genicular nerve block with corticosteroid for chronic knee Pain: Patient-Reported outcomes across 9-years of practice

Background

Genicular nerve blocks (GNB) for knee pain secondary to osteoarthritis (OA) are often performed with an anesthetic only, but corticosteroid can be used as an adjuvant with the goal of extending therapeutic relief. The efficacy of GNB with corticosteroid has been established in small, randomized trials, but its effectiveness in practice remains largely unknown.

Objectives

Evaluate the therapeutic effect of GNB with corticosteroid using patient-reported outcomes (PROs) in a large patient sample.

Methods

Data from consecutive GNBs with corticosteroid performed at an academic medical center from 2015 to 2024 was collected retrospectively. We included all patients aged ≥18 who received a GNB with corticosteroid for chronic knee pain due to OA, and excluded diagnostic GNBs with anesthetic alone and procedures performed using non-classical/modified techniques. Comparisons between pre-versus post-procedure PROs were by mixed-effect regression models with multiple testing corrections.

Results

A total of 123 GNBs (96 patients) with corticosteroid were identified. Post-procedurally, the mean NRS reductions were 3.56 (2–30 days), 2.14 (1–3 months), 1.92 (3–6 months), and 1.23 (6–12 months). 50 % of the patients maintained a pain reduction greater than or equal to the NRS MCID of −2.0 for at least 6.9 months. Post-procedure improvements in PROMIS-GH and PHQ9 were not clinically significant. Mean time to total knee arthroplasty was 16.5 months in 13.5 % of patients (13/96). For active opioid users, opioid usage was significantly decreased from the baseline 28.01 ± 13.20 MME/day to 13.58 ± 16.23 MME/day (p < 0.002) in the first 6 months post-GNB, and this opioid reduction was maintained at 15.59 ± 12.51 MME/day (p < 0.05) after the initial 6-month follow-up period.

Conclusion

For the majority of patients who received GNB with corticosteroid, we observed statistically and clinically significant pain reduction for 3 months or more in this cohort. While more comparative studies are required to evaluate its effectiveness, GNB with corticosteroid has promising potential as a safe and effective treatment for chronic knee pain.