Gen-Nerve-Procedures

 

Pain can be experienced in the knee due to degenerative changes or arthritis. The genicular nerves conduct pain signals from the knee joint to the brain. These nerves are a target for pain therapy.

 

What is a Genicular Nerve Block?

The procedure involves injecting local anaesthetic, with or without steroid, besides the genicular nerves. This will block the nerves from transmitting pain from the knee. This will test whether or not you are likely to respond to radiofrequency neurotomy of the Genicular Nerves.

 

What is a Genicular Nerve Radiofrequency Neurotomy?

This is a sophisticated procedure that works to combat knee pain and provide long term relief. This can be done prior to or following knee surgery, and can prevent, or postpone, the need for further invasive surgeries.

This innovative option involves placing needles beside the genicular nerves. Then a computer will raise the temperature of the tip of the needle and surrounding tissues using a radiofrequency generator to cauterize the nerves.

Alternatively, the computer can “pulse” a radiofrequency signal onto the nerve in an attempt to modulate (change) its function.

If the patient has shown a positive response to the genicular nerve blocks, this procedure will then be offered.

 

How long will the pain relief last after Genicular Nerve Radiofrequency Neurotomy?

The cause and location of pain can alter how long the pain relief will last after the procedure. On average, patients can expect pain to be alleviated for 9 to 12 months after undergoing radiofrequency neurotomy. However, this can range anywhere from 3 to 24 months.

This procedure is not guaranteed to always be effective. Pain relief is never permanent, as the nerves repair and pain may return. If pain returns, a repeat of the procedure may be desired.

If the patient has undertaken pulsed radiofrequency treatment, pain relief may last for up to 3 to 6 months.

 

Will I be awake during the procedure?

All patients will have the option of being sedated during the procedure. This is often a popular choice, as it means a reduced risk of discomfort. While it is not a guarantee, it is likely you will have little to no memory of the procedure.

 

Is the procedure painful?

To alleviate pain, local anaesthetic is administered at the beginning of the procedure. Patients may find they experience discomfort during the procedure, or afterwards once the numbing wears off.

 

How do I prepare for the procedure?

It is vital to notify your medical specialist if you are:

  • Diabetic
  • Pregnant
  • Suffering allergies
  • Have an infection or feeling unwell
  • Taking blood thinners – these can often be continued
  • Have a medical device implanted

 

You may be advised by your medical specialist to:

  • Arrange for somebody to transport you home
  • Continue taking usual medication
  • Avoid eating for 6 hours prior to the procedure
  • Avoid drinking for 3 hours prior to the procedure (clear fluids only up until then)

 

What does the procedure involve?

We want to ensure you know what to expect on the day of the procedure. After arriving and completing paperwork, you will:

  • Be changed into a hospital gown
  • Have discussion with an anaesthetist if you elected to have sedation
  • Have a small cannula inserted into one of your veins
  • May be given a mild sedative and painkiller
  • During the procedure, your oxygen levels, heart rate and blood pressure will continually be monitored
  • Lying face-up on the x-ray table, the skin over the injection area will be cleaned with antiseptic solution. Sterile drapes will also be applied
  • At this stage a further anaesthetic may be injected
  • A small needle will be guided towards the correct target through the use of an x-ray machine
  • The radiofrequency treatment is performed by a sophisticated computer
  • Final anaesthetic and/or steroid solution will be injected
  • Further multiple injections may be required.

In total the procedure will only take between 15 to 30 minutes, with the addition of recovery time.

 

What are the potential complications?

While this procedure is generally considered to be safe, as with every invasive procedure it carries certain risks and complications. While these do not have a high chance of occurring, risks include:

  • Bruising
  • Bleeding
  • Infection
  • Discomfort at the site of the injection
  • Allergic reactions
  • The procedure may fail to alleviate pain

Please discuss with your doctor or anaesthetics about the risks of sedation.

 

What happens after the procedure?

  • Until you are ready to go home, you will be transferred and monitored in a recovery area. This generally takes 60 to 90 minutes.
  • You will be required to be accompanied home by a friend or relative, and ensure they are able to stay with you overnight.
  • Side effects of any received sedation can last for 24 hours. This can cause you to forget information received during the procedure. This is nothing to worry about and is caused by the medication.
  • Because of the given medication, it is important that in the 24 hours following the procedure you do not operate a vehicle or heavy machinery, consume alcoholic beverages, sign legal documents, make important decisions or travel alone.
  • The dressing is able to be removed the following day when you bathe.
  • You may experience an increase of pain once the local anaesthetic wears off. Patients can often experience pain and stiffness for the following few days after the procedure. A solution to this pain is ice the area for 10 minutes at a time for 1 to 2 days. Otherwise, painkillers will help to alleviate discomfort.
  • You may be given a pain relief chart to fill out. Please keep this handy to refer to when you are phoned by the QPain nurse (which will happen within 24-48 hours) to discuss the outcome and organise any follow up appointments.
  • If steroids were used during your procedure it may take numerous days to notice any benefits. Steroids can also cause patients to have a flushed face and have mood swings for a few days. If you are diabetic, you may also suffer from a rise in blood sugar levels.
  • It is recommended to gradually reintroduce strenuous physical activity as tolerated.
  • Contact QPain, your General Practitioner, or your Emergency Department if you have any severe pain, swelling, discharge or bleeding from the site of the injection.

 

Consent

Prior to undergoing the procedure, make sure you are completely informed about what will happen during and after the procedure, and what the potential side effects and risks are. If you are unsure about any part of the procedure or need more information, it is highly recommended to discuss these matters with your doctor.

Once you have requested to undertake the procedure, you will be required to sign a form of consent. You will need to know about the risks, benefits, alternatives and what is likely to occur if you do not proceed. Once you have signed this form, you are able to change your mind and withdraw consent at any time right up until the start of the procedure.

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