A prospective randomized trial of prognostic genicular nerve blocks to determine the predictive value for the outcome of cooled radiofrequency ablation for chronic knee pain due to osteoarthritis

Zachary L. McCormick*, Rajiv Reddy, Marc Korn, David Dayanim, Raafay H. Syed, Meghan Bhave, Mikhail Zhukalin, Sarah Choxi, Ali Ebrahimi, Mark C. Kendall, Robert J. McCarthy, Dost Mohammad Khan, Geeta Nagpal, Karina J Bouffard, David R Walega

*Corresponding author for this work

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background and Objectives. Genicular nerve radiofrequency ablation is an effective treatment for patients with chronic pain due to knee osteoarthritis; however, little is known about factors that predict procedure success. The current study evaluated the utility of genicular nerve blocks to predict the outcome of genicular nerve cooled radiofrequency ablation (cRFA) in patients with osteoarthritis. Methods. This randomized comparative trial included patients with chronic knee pain due to osteoarthritis. Participants were randomized to receive a genicular nerve block or no block prior to cRFA. Patients receiving a prognostic block that demonstrated 50% pain relief for six hours received cRFA. The primary outcome was the proportion of participants with 50% reduction in knee pain at six months. Results. Twenty-nine participants (36 knees) had cRFA following a prognostic block, and 25 patients (35 knees) had cRFA without a block. Seventeen participants (58.6%) in the prognostic block group and 16 (64.0%) in the no block group had 50% pain relief at six months (P 5 0.34). A 15-point decrease in the Western Ontario and McMaster Universities Osteoarthritis Index at six months was present in 17 of 29 (55.2%) in the prognostic block group and 15 of 25 (60%) in the no block group (P 5 0.36). Conclusions. This study demonstrated clinically meaningful improvements in pain and physical function up to six months following cRFA. A prognostic genicular nerve block using a local anesthetic volume of 1 mL at each injection site and a threshold of 50% pain relief for subsequent cRFA eligibility did not improve the rate of treatment success.

Original languageEnglish (US)
Pages (from-to)1628-1638
Number of pages11
JournalPain Medicine (United States)
Volume19
Issue number8
DOIs
StatePublished - Jan 1 2018

Fingerprint

Nerve Block
Chronic Pain
Osteoarthritis
Knee
Pain
Pain Threshold
Knee Osteoarthritis
Ontario
Local Anesthetics
Injections
Therapeutics

Keywords

  • Anesthetics
  • Chronic Pain
  • Clinical Prediction Rule
  • Knee
  • Local
  • Osteoarthritis
  • Radiofrequency Catheter Ablation

ASJC Scopus subject areas

  • Clinical Neurology
  • Anesthesiology and Pain Medicine

Cite this

McCormick, Zachary L. ; Reddy, Rajiv ; Korn, Marc ; Dayanim, David ; Syed, Raafay H. ; Bhave, Meghan ; Zhukalin, Mikhail ; Choxi, Sarah ; Ebrahimi, Ali ; Kendall, Mark C. ; McCarthy, Robert J. ; Khan, Dost Mohammad ; Nagpal, Geeta ; Bouffard, Karina J ; Walega, David R. / A prospective randomized trial of prognostic genicular nerve blocks to determine the predictive value for the outcome of cooled radiofrequency ablation for chronic knee pain due to osteoarthritis. In: Pain Medicine (United States). 2018 ; Vol. 19, No. 8. pp. 1628-1638.
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title = "A prospective randomized trial of prognostic genicular nerve blocks to determine the predictive value for the outcome of cooled radiofrequency ablation for chronic knee pain due to osteoarthritis",
abstract = "Background and Objectives. Genicular nerve radiofrequency ablation is an effective treatment for patients with chronic pain due to knee osteoarthritis; however, little is known about factors that predict procedure success. The current study evaluated the utility of genicular nerve blocks to predict the outcome of genicular nerve cooled radiofrequency ablation (cRFA) in patients with osteoarthritis. Methods. This randomized comparative trial included patients with chronic knee pain due to osteoarthritis. Participants were randomized to receive a genicular nerve block or no block prior to cRFA. Patients receiving a prognostic block that demonstrated 50{\%} pain relief for six hours received cRFA. The primary outcome was the proportion of participants with 50{\%} reduction in knee pain at six months. Results. Twenty-nine participants (36 knees) had cRFA following a prognostic block, and 25 patients (35 knees) had cRFA without a block. Seventeen participants (58.6{\%}) in the prognostic block group and 16 (64.0{\%}) in the no block group had 50{\%} pain relief at six months (P 5 0.34). A 15-point decrease in the Western Ontario and McMaster Universities Osteoarthritis Index at six months was present in 17 of 29 (55.2{\%}) in the prognostic block group and 15 of 25 (60{\%}) in the no block group (P 5 0.36). Conclusions. This study demonstrated clinically meaningful improvements in pain and physical function up to six months following cRFA. A prognostic genicular nerve block using a local anesthetic volume of 1 mL at each injection site and a threshold of 50{\%} pain relief for subsequent cRFA eligibility did not improve the rate of treatment success.",
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A prospective randomized trial of prognostic genicular nerve blocks to determine the predictive value for the outcome of cooled radiofrequency ablation for chronic knee pain due to osteoarthritis. / McCormick, Zachary L.; Reddy, Rajiv; Korn, Marc; Dayanim, David; Syed, Raafay H.; Bhave, Meghan; Zhukalin, Mikhail; Choxi, Sarah; Ebrahimi, Ali; Kendall, Mark C.; McCarthy, Robert J.; Khan, Dost Mohammad; Nagpal, Geeta; Bouffard, Karina J; Walega, David R.

In: Pain Medicine (United States), Vol. 19, No. 8, 01.01.2018, p. 1628-1638.

Research output: Contribution to journalArticle

TY - JOUR

T1 - A prospective randomized trial of prognostic genicular nerve blocks to determine the predictive value for the outcome of cooled radiofrequency ablation for chronic knee pain due to osteoarthritis

AU - McCormick, Zachary L.

AU - Reddy, Rajiv

AU - Korn, Marc

AU - Dayanim, David

AU - Syed, Raafay H.

AU - Bhave, Meghan

AU - Zhukalin, Mikhail

AU - Choxi, Sarah

AU - Ebrahimi, Ali

AU - Kendall, Mark C.

AU - McCarthy, Robert J.

AU - Khan, Dost Mohammad

AU - Nagpal, Geeta

AU - Bouffard, Karina J

AU - Walega, David R

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background and Objectives. Genicular nerve radiofrequency ablation is an effective treatment for patients with chronic pain due to knee osteoarthritis; however, little is known about factors that predict procedure success. The current study evaluated the utility of genicular nerve blocks to predict the outcome of genicular nerve cooled radiofrequency ablation (cRFA) in patients with osteoarthritis. Methods. This randomized comparative trial included patients with chronic knee pain due to osteoarthritis. Participants were randomized to receive a genicular nerve block or no block prior to cRFA. Patients receiving a prognostic block that demonstrated 50% pain relief for six hours received cRFA. The primary outcome was the proportion of participants with 50% reduction in knee pain at six months. Results. Twenty-nine participants (36 knees) had cRFA following a prognostic block, and 25 patients (35 knees) had cRFA without a block. Seventeen participants (58.6%) in the prognostic block group and 16 (64.0%) in the no block group had 50% pain relief at six months (P 5 0.34). A 15-point decrease in the Western Ontario and McMaster Universities Osteoarthritis Index at six months was present in 17 of 29 (55.2%) in the prognostic block group and 15 of 25 (60%) in the no block group (P 5 0.36). Conclusions. This study demonstrated clinically meaningful improvements in pain and physical function up to six months following cRFA. A prognostic genicular nerve block using a local anesthetic volume of 1 mL at each injection site and a threshold of 50% pain relief for subsequent cRFA eligibility did not improve the rate of treatment success.

AB - Background and Objectives. Genicular nerve radiofrequency ablation is an effective treatment for patients with chronic pain due to knee osteoarthritis; however, little is known about factors that predict procedure success. The current study evaluated the utility of genicular nerve blocks to predict the outcome of genicular nerve cooled radiofrequency ablation (cRFA) in patients with osteoarthritis. Methods. This randomized comparative trial included patients with chronic knee pain due to osteoarthritis. Participants were randomized to receive a genicular nerve block or no block prior to cRFA. Patients receiving a prognostic block that demonstrated 50% pain relief for six hours received cRFA. The primary outcome was the proportion of participants with 50% reduction in knee pain at six months. Results. Twenty-nine participants (36 knees) had cRFA following a prognostic block, and 25 patients (35 knees) had cRFA without a block. Seventeen participants (58.6%) in the prognostic block group and 16 (64.0%) in the no block group had 50% pain relief at six months (P 5 0.34). A 15-point decrease in the Western Ontario and McMaster Universities Osteoarthritis Index at six months was present in 17 of 29 (55.2%) in the prognostic block group and 15 of 25 (60%) in the no block group (P 5 0.36). Conclusions. This study demonstrated clinically meaningful improvements in pain and physical function up to six months following cRFA. A prognostic genicular nerve block using a local anesthetic volume of 1 mL at each injection site and a threshold of 50% pain relief for subsequent cRFA eligibility did not improve the rate of treatment success.

KW - Anesthetics

KW - Chronic Pain

KW - Clinical Prediction Rule

KW - Knee

KW - Local

KW - Osteoarthritis

KW - Radiofrequency Catheter Ablation

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U2 - 10.1093/pm/pnx286

DO - 10.1093/pm/pnx286

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JF - Pain Medicine

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