Accuracy of fluoroscopic-guided genicular nerve blockade: a need for revisiting anatomical landmarks.

Autor:	Fonkoue L; Department of Morphology, Experimental and Clinical Research Institute, Universite catholique de Louvain, Brussels, Belgium loic.fonkoue@uclouvain.be.; Neuro-Musculo-Skeletal Department (NMSK), Experimental and Clinical Research Institute, Université catholique de Louvain, Brussels, Belgium., Behets CW; Department of Morphology, Experimental and Clinical Research Institute, Universite catholique de Louvain, Brussels, Belgium., Steyaert A; Department of Anesthesia and Pain Medicine, Cliniques universitaires Saint-Luc, Bruxelles, Belgium.; Institute of Neuroscience (IONS), Universite catholique de Louvain, Brussels, Belgium., Kouassi JK; Neuro-Musculo-Skeletal Department (NMSK), Experimental and Clinical Research Institute, Université catholique de Louvain, Brussels, Belgium., Detrembleur C; Neuro-Musculo-Skeletal Department (NMSK), Experimental and Clinical Research Institute, Université catholique de Louvain, Brussels, Belgium., De Waroux BLP; Department of Anesthesia and Pain Medicine, Cliniques universitaires Saint-Luc, Bruxelles, Belgium., Cornu O; Neuro-Musculo-Skeletal Department (NMSK), Experimental and Clinical Research Institute, Université catholique de Louvain, Brussels, Belgium.; Department of Orthopedics and Trauma, Cliniques universitaires Saint-Luc, Bruxelles, Belgium.
Jazyk:	angličtina
Zdroj:	Regional anesthesia and pain medicine [Reg Anesth Pain Med] 2019 Aug 26. Date of Electronic Publication: 2019 Aug 26.
DOI:	10.1136/rapm-2019-100451
Abstrakt:	Background and Objectives: Genicular nerve blockade (GNB) and radiofrequency ablation (RFA) have recently emerged as treatment options for patients with chronic knee pain. However, an increasing number of anatomical studies and systematic reviews concluded that the anatomical basis for needle placement was unclear, incomplete and somewhat inaccurate. This study was designed to assess the accuracy of updated anatomical landmarks for fluoroscopy-guided blockade of the consistent genicular nerves in a cadaveric model. Methods: Based on a comprehensive review of recent anatomical studies and prior dissection of 21 fresh cadaver knees, we defined bony landmarks with high likelihood of successful ablation of the five consistent genicular nerves (GN). We tested the accuracy of GNBs using the above-stated anatomical landmarks in 10 intact fresh cadaveric knees. Needle placement was guided by fluoroscopy and 0.5 mL of 0.1% methylene blue was injected at the site of each nerve. The knees were subsequently dissected to assess the accuracy of the injections. If the nerve was dyed with blue ink, the placement was considered accurate. Results: The accuracy of our injections was 100% for the superior medial genicular nerve, inferior medial GN, infrapatellar branch of saphenous nerve and recurrent fibular nerve. The superior lateral GN was dyed in 90% of specimens. Conclusion: This study provides physicians with precise anatomical landmarks for the five consistent GN for fluoroscopic-guided GNB. Our revised technique, which targets more nerves with increased accuracy, could potentially lead to improved therapeutic benefits on chronic knee pain. Competing Interests: Competing interests: None declared. (© American Society of Regional Anesthesia & Pain Medicine 2019. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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