64454 Injection(s), anesthetic agent(s) and/or steroid; genicular nerve branches, including imaging guidance, when performed

Name of the Procedure:

Injection(s), anesthetic agent(s) and/or steroid; genicular nerve branches, including imaging guidance, when performed.

Summary

In this procedure, a doctor injects an anesthetic or steroid medication into specific nerves around the knee called genicular nerve branches. These injections are guided by imaging techniques like X-rays or ultrasound to ensure accuracy. This is often done to relieve chronic knee pain.

Purpose

The primary purpose of this procedure is to alleviate chronic knee pain, especially in cases where other treatments have failed. It aims to reduce inflammation and block pain signals from the knee to provide relief.

Indications

• Chronic knee pain not responsive to conservative treatments like physical therapy or medications.
• Osteoarthritis of the knee.
• Pain from a previous knee surgery.
• Candidates should not have infections near the injection site or severe allergies to the anesthetics or steroids used.

Preparation

• Patients may need to fast for a few hours before the procedure.
• Certain medications, like blood thinners, might need to be adjusted.
• Patients should provide a full medical history including allergies and current medications.

Procedure Description

1. The patient lies on an examination table.
2. The area around the knee is sterilized.
3. Local anesthesia may be applied to numb the skin.
4. Using imaging guidance, the doctor carefully inserts a needle into the genicular nerve branches.
5. The anesthetic and/or steroid medication is injected.
6. The needle is removed, followed by a small bandage placed on the injection site.

Duration

The procedure typically takes around 20 to 30 minutes.

Setting

Performed in an outpatient clinic, hospital, or surgical center.

Personnel

• Interventional pain specialist or anesthesiologist.
• Radiology technician to assist with imaging guidance.
• Nursing staff for assistance and patient care.

Risks and Complications

• Common: Pain at injection site, temporary increase in pain, infection, bleeding.
• Rare: Nerve damage, allergic reactions to injected medications.
• Management typically involves symptomatic treatment, like the use of ice packs or medications for pain relief.

Benefits

• Expected benefits include substantial pain relief and improved knee function.
• Benefits might be realized within a few days to a week after the procedure.

Recovery

• Patients can usually go home shortly after the procedure.
• Mild soreness at the injection site is common and can be managed with ice and over-the-counter pain relievers.
• Most patients can resume normal activities within a day, but strenuous activities should be avoided for a few days.
• Follow-up appointments might be needed to assess the effectiveness of the treatment.

Alternatives

• Physical therapy
• Pain medication
• Knee braces or orthotics
• Other types of nerve blocks or injections (e.g., hyaluronic acid, platelet-rich plasma)
• Surgical options like knee replacement
• Each alternative has its own benefits and drawbacks compared to the genicular nerve block.

Patient Experience

• Patients may feel a brief sting when the needle is inserted and might experience pressure or mild discomfort during the injection.
• Afterward, some might feel immediate but temporary pain relief due to the anesthetic.
• Long-term pain relief usually develops over several days.
• Comfort measures include ice packs, rest, and mild analgesics to manage post-procedure soreness.