Comparative evaluation of ultrasound guided pulsed radio frequency treatment of saphenous nerve and genicular nerve block vs genicular nerve block alone for patients with knee joint osteoarthritis pain: a prospective randomized study

Osteoarthritis of the knee joint is a troublesome disease particularly in the elderly population. It is characterized by pain and stiffness of the knee joint. its management include lifestyle modifications, use of paracetamol, non-steroidal anti-inflammatory disease, and total knee replacement in resistant cases. Interventional treatment employs the use of nerve blocks and intraarticular supplementation to provide pain relief to these patients. The knee joint is supplied by genicular branches of femoral, tibial, common peroneal, saphenous and obturator nerves. Genicular nerve blocks have been used in these patients with satisfactory short-term outcomes. Pulsed radiofrequency of peripheral nerves is being utilized to enhance the analgesic efficacy of nerve blocks. The present study hypothesizes that combination of pulsed radiofrequency of saphenous nerve and genicular nerve block is better than genicular nerve block alone to relieve the pain of knee joint osteoarthritis. This study will be conducted in 60 patients divided randomly into 2 equal groups of 30 each. One group will be given combined pulsed radiofrequency of saphenous nerve and genicular nerve block and another group genicular nerve block alone. The pulsed radiofrequency of the saphenous nerve will be done at 42⁰C and 45 V for 8 minutes under ultrasound guidance. The ultrasound guided genicular nerve block of 3 nerves i.e.  superomedial, superolateral and inferomedial genicular nerves will be done with 1 ml of 0.5% bupivacaine.  These patients will be evaluated with visual analogue score (VAS) and Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) score at baseline, 1 week, 1 month, 3-month and 6-month post procedure to assess the efficacy of the procedures. Any adverse effects experienced by the patients will also be recorded during the study period.