A promising treatment option for pain relief for patients with osteoarthritis of the knee

A study, published in Arthritis & Rheumatology, aimed to determine the effectiveness of ultrasound-guided genicular nerve block for the management of pain in patients with knee osteoarthritis. The authors of the study1 point out that the worldwide prevalence of knee osteoarthritis is approximately 23% in adults over the age of 40. There are few recommended pharmacotherapeutic options for this condition. Joint replacement surgery is considered a definitive treatment strategy. But for many patients, such as the frail or elderly or with complex comorbidities, surgery may not be appropriate. Genicular nerve block (GNB) is a new therapeutic intervention using a variety of agents that target multiple branches of the nerve innervating the knee joint and are safely accessible with ultrasound.4 Read: Updated U.S. guidelines for treatment of osteoporosis or low bone mass A recent review suggested that among published studies, the application of GNB can provide pain relief for up to three months.5 Elements of methodology A randomized, placebo-controlled, parallel-group, 12-week trial was conducted in patients at the Southern Adelaide Health Network in Adelaide, South Australia, with a primary diagnosis of symptomatic osteoarthritis of the knee. Within two weeks of randomization, patients in the active group received three injections of 5.7 mg celestone chronodose (1 mL) and 0.5% bupivacaine (3 mL) into the infero-medial genicular nerves, superomedial and superolateral. Patients in the placebo group received injections of saline. At the start of the study and at weeks 2, 4, 8 and 12, patients rated their pain and disability on a 100 mm visual analogue scale (VAS) (the primary endpoint), on the index of Osteoarthritis from Western Ontario and McMasters Universities (WOMAC) and the Intermittent and Constant Osteoarthritis Pain Scale. Read: Can treating pre-symptomatic rheumatoid arthritis delay onset? Principle results Between 2020 and 2021, 95 patients were evaluated to be eligible for the study. A total of 59 patients (36 women and 23 men, mean age 68.2 ± 8.6 years) completed the study (n = 31 in the active group, n = 28 in the placebo group). There were no significant differences in demographic and clinical characteristics (age, gender, disease duration, baseline pain scores) between the two groups. Patients in the active group reported improvement in pain scores at weeks 2, 4, 8, and 12, with diminishing effect over time. The VAS scores at baseline and at weeks 2, 4, 8, and 12 in the active group compared to the placebo group were 6.2 versus 5.3 (p = 0.294), 2.7 versus 4.7 (p = 0.294), respectively. < 0.001), 3.2 versus 5.1 (p < 0.001), 3.9 versus 4.9 (p < 0.001) and 4.6 versus 5.1 (p = 0.055). WOMAC scores at baseline and at weeks 2, 4, 8 and 12 in the active group compared to the placebo group were 54.5 vs 48.1 (p=0.177), 32.9 vs 44.4 (p=0.177), 32.9 vs 44.4 (p < 0.001), 33.7 versus 45.8 (p < 0.001), 39.2 versus 44.8 (p = 0.001) and 42.6 versus 45.1 (p = 0.012). In conclusion, 74% of patients in the active group declared that their condition had improved or greatly improved at week 2 compared to 25% of patients in the placebo group (p < 0.001). No adverse effects were reported in the study patients. The ultrasound-guided GNB procedure may be safer than currently available drug therapies. In addition, a single intervention offered over three months may be of substantial benefit to some patients compared to regular oral medication. References 1. Shanahan, E.M. et al. (2023). Genicular Nerve Block for Pain Management in Patients With Knee Osteoarthritis: A Randomized Placebo-Controlled Trial. Arthritis & Rheumatology 75(2), 201-209. 2. Kolasinki, S.L. et al. (2020). 2019 American College of Rheumatology/Arthritis Foundation guideline for the management of osteoarthritis of the hand, hip, and knee. Arthritis Care Res (Hoboken) 72, 149-62. 3. Bannuru, R.R. et al. (2019). OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis Cartilage 27, 1578-89. 4. Yasar, E.E. et al. (2015). Accuracy of ultrasound-guided genicular nerve block: a cadaveric study. Pain Physician 18, E899-904. 5. Tan, Y., Rui, E. and Wee, T. (2022). Ultrasound-guided genicular nerve blockade with pharmacological agents for chronic knee osteoarthritis: a systematic review. Pain Physician 25, E489-502. This article has been translated from its original French and first appeared on our sister site Profession Santé.

A promising treatment option for pain relief for patients with osteoarthritis of the knee

Register for free access or login.

Related Topics