Nerve block to combat chronic knee pain

Written by: Dr Sarang Puranik
Edited by: Laura Burgess

What is a genicular nerve block?

The relatively new procedure genicular nerve block is done to treat knee pain. It is mainly done for the intractable pain of osteoarthritis where either surgery is not possible or, in some situations, when you still have severe pain after total knee replacement surgery.



What is the purpose of the nerve block?

The purpose of the genicular nerve block is to alleviate chronic knee pain and reduce the use of long-term painkillers.


How is the procedure performed?

In this procedure, some of the important nerves around the knee joint are blocked with a local anaesthetic with or without steroids, under ultrasound and X-ray guidance by a pain management specialist. You will need to come to the hospital on the day of the procedure for half a day. The actual procedure is done in the operation theatre under very sterile conditions.

Is a genicular nerve block a painful procedure?

This procedure is done in very sterile conditions to avoid any chances of infection. It is done in an operation theatre with the patient lying on their back. The affected knee is then thoroughly cleaned just like when you have an operation. Under X-ray guidance, local anaesthetic injections are given around the knee, generally in three places. This makes the entrance of the block needle much less painful. Three block needles are then placed around the knee and local anaesthetic sometimes mixed with steroid is then given. Sometimes this can be little uncomfortable. After finishing this procedure you are then able to walk on your own. You may also feel the pain relief within few minutes.


What are the risks of a nerve block?

The risks of the genicular nerve block pain relief procedure may include:

  • Bruising
  • Temporary increase in pain around the area.
  • Infection, for which sometimes you may be given antibiotics.
  • Very small chances of bleeding.
  • In some rare cases, there may not be the expected pain relief.


How long does it take for the procedure to work?

This procedure takes around half an hour per knee on the day and can provide pain relief for a few days to a few weeks. After establishing that these test blocks are successful, another procedure is done which is called a nerve ablation, which uses heat with a specialist machine. This procedure can give long-term pain relief lasting for many weeks and it is performed on another day, again in the operation theatre in sterile conditions.


By Dr Sarang Puranik
Pain medicine

Dr Sarang Puranik is an expert in chronic pain management and anaesthesia, with a special interest in treating back, neck and neuropathic pain. He uses treatments and procedures, which include facet joint injections, epidural in the back, nerve root injections and radiofrequency denervation to manage the discomfort felt by his patients.

Dr Puranik has an MD in anaesthesia from Pune University, India. He completed his higher specialist training at St George’s, London and its rotation hospitals. Dr Puranik has been a consultant in anaesthesia and pain management at Kingston Hospital Foundation Trust since 2003.

He also holds clinics at Parkside Hospital, Wimbledon, St Anthony's Hospital, Sutton and New Victoria Hospital, Kingston-upon-Thames, and works in close association with physiotherapists and other physical therapists.

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