64624 Destruction by neurolytic agent, genicular nerve branches including imaging guidance, when performed

Name of the Procedure:

Destruction by Neurolytic Agent, Genicular Nerve Branches Including Imaging Guidance

Summary

This procedure involves the destruction of genicular nerve branches using a neurolytic agent to alleviate chronic knee pain. Imaging guidance, such as fluoroscopy or ultrasound, is used to ensure precise targeting of the nerves.

Purpose

This procedure aims to reduce or eliminate chronic knee pain, primarily caused by conditions such as osteoarthritis or post-surgical pain. By destroying specific nerve branches that transmit pain signals, patients can experience significant pain relief, improving their quality of life and mobility.

Indications

• Chronic knee pain unresponsive to conservative treatments (e.g., physical therapy, medications)
• Osteoarthritis of the knee
• Persistent pain following knee surgery
• Patients with contraindications for knee surgery or those seeking non-surgical pain relief

Preparation

• Patients may need to fast for a few hours before the procedure.
• Medications may be adjusted, particularly blood thinners, to prevent complications.
• Pre-procedure imaging tests, like X-rays or MRI, may be conducted to map the knee anatomy.

Procedure Description

1. The patient is positioned to allow easy access to the knee.
2. Local anesthesia is administered to numb the injection site.
3. Imaging guidance (fluoroscopy or ultrasound) is utilized to visualize the genicular nerves.
4. A fine needle is inserted through the skin to target the nerve branches.
5. A neurolytic agent (e.g., alcohol, phenol) is injected to disrupt nerve function.
6. The procedure may involve multiple injections to cover all relevant nerve branches.

Duration

The procedure typically takes about 30 to 60 minutes.

Setting

The procedure is usually performed in an outpatient clinic or surgical center equipped with imaging technology.

Personnel

• Interventional pain specialist or anesthesiologist
• Nurse or medical assistant
• Radiologic technologist (if imaging is used)

Risks and Complications

• Common: Temporary pain at the injection site, bruising, or swelling
• Rare: Infection, bleeding, numbness, or weakness in the leg
• In very rare cases, accidental damage to surrounding tissues or blood vessels may occur.

Benefits

• Significant pain relief, often within a few days
• Improved joint function and mobility
• Decreased need for pain medications
• Non-surgical alternative for chronic knee pain management

Recovery

• Patients can usually go home the same day.
• Mild soreness at the injection site is common but typically resolves within a few days.
• Patients are advised to rest and avoid strenuous activities for at least 24 hours.
• Follow-up appointments may be scheduled to assess the procedure's effectiveness and discuss further pain management strategies if needed.

Alternatives

• Physical therapy and exercises
• Oral or topical pain medications
• Corticosteroid injections
• Hyaluronic acid injections
• Knee replacement surgery for severe cases

Pros of alternatives:

• Non-invasive options (physical therapy, medications)
• Long-term relief with surgery

Cons of alternatives:

• Variable effectiveness of medications and injections
• Surgical risks and longer recovery time for knee replacement

Patient Experience

• During the procedure: A brief sting or burning sensation during needle insertion and injection. Most of the procedure is pain-free due to local anesthesia.
• After the procedure: Mild soreness or discomfort at the injection site. Pain relief may be noticed within a few days. Pain management options, such as over-the-counter pain relievers, can be used if needed.