Chemical neurolysis of the genicular nerves for chronic refractory knee pain: an observational cohort study

Abstract

Abstract Objective Evaluate outcomes of genicular nerve chemical neurolysis (GChN) in a real-world population with chronic knee pain. Design Restrospective, observational cohort study. Setting Tertiary academic medical center. Subjects Consecutive patients who had undergone GChN ≥3 months prior. Methods Standardized surveys were collected by telephone and included the numerical rating scale, opioid analgesic use, and Patient Global Impression of Change. Age, sex, body mass index, duration of pain, history of arthroplasty, lack of effect from previous radiofrequency ablation, percentage relief from a prognostic block, and volume of phenol used at each injection site were extracted from charts. Descriptive statistics were calculated, and logistic regression analyses were performed to identify factors influencing treatment outcome. Results At the time of follow-up after GChN (mean ± SD: 9.9 ± 6.1 months), 43.5% (95% CI = 33.5–54.1) of participants reported ≥50% sustained pain reduction. On the Patient Global Impression of Change assessment, 45.9% (95% CI = 35.5–56.7) of participants reported themselves to be “very much improved” or “much improved.” Of 40 participants taking opioids at baseline, 11 (27.5%; 95% CI = 14.6–43.9) ceased use. Of participants with a native knee treated, 46.3% reported ≥50% pain reduction, whereas of participants with an arthroplasty in the treated knee, 33.3% reported this threshold of pain reduction (P = .326). Logistic regression analyses did not reveal associations between treatment success and any of the factors that we evaluated. Conclusions GChN could provide a robust and durable treatment effect in a subset of individuals with chronic knee pain with complicating factors traditionally associated with poor treatment outcomes, such as those with pain refractory to radiofrequency ablation or those who have undergone arthroplasty.