Barasker Swapnil Kumar, Jain Anuj, Gautam Sujeet, Saxena Dipti
Department of Anesthesiology, Sri Aurobindo Medical College and Post Graduate Institute, Indore, India.
Department of Anesthesiology, All India Institute of Medical Sciences Bhopal, Bhopal, India.
Ochsner J. 2024 Winter;24(4):303-308. doi: 10.31486/toj.24.0038.
Knee osteoarthritis is a chronic degenerative disease associated with pain and decreased mobility that affects advanced-age individuals, thus causing further debilitation. Radiofrequency ablation can benefit patients who are not ideal candidates for surgical intervention and for whom conservative management has been unsatisfactory. Currently, radiofrequency ablation is performed using either ultrasonography or fluoroscopy. In this technique review, we propose a method of performing cooled radiofrequency ablation of the genicular nerves that uses both ultrasonography and fluoroscopy and that could be helpful for novice pain practitioners. We report the experience of 2 patients with grade 4 osteoarthritis knee joints who underwent our cooled radiofrequency ablation technique. Each patient received a diagnostic block using ultrasonography, with ≥70% pain relief the prerequisite for performing cooled radiofrequency ablation. Our radiofrequency ablation technique involves using ultrasonography to identify and mark the superomedial, superolateral, and inferomedial genicular arteries. The marking done with ultrasonography is used during needle insertion with fluoroscopy guidance to reach the target points, and the final position of the needle is confirmed using sensory and motor stimulation before the cooled radiofrequency ablation procedure is performed. The cooled radiofrequency ablation resulted in pain reduction as measured on the visual analog scale and the Western Ontario and McMaster Universities Osteoarthritis Index scores at both patients' 3- and 6-month follow-ups. Using this technique for cooled radiofrequency ablation of the genicular nerves might help to reduce radiation exposure, specifically when the procedure is being performed by novice practitioners with limited experience.
膝关节骨关节炎是一种与疼痛和活动能力下降相关的慢性退行性疾病，影响老年人，从而导致进一步的身体衰弱。射频消融术对那些不适合手术干预且保守治疗效果不佳的患者有益。目前，射频消融术是使用超声或荧光透视来进行的。在本技术综述中，我们提出一种使用超声和荧光透视进行膝神经冷冻射频消融的方法，这可能对新手疼痛治疗医生有所帮助。我们报告了2例4级膝关节骨关节炎患者接受我们的冷冻射频消融技术的经验。每位患者在超声引导下接受诊断性阻滞，疼痛缓解≥70%是进行冷冻射频消融的前提条件。我们的射频消融技术包括使用超声识别并标记膝上内侧、膝上外侧和膝下内侧动脉。在荧光透视引导下进针到达靶点时使用超声标记，在进行冷冻射频消融术前通过感觉和运动刺激确认针的最终位置。在两位患者的3个月和6个月随访中，冷冻射频消融术使视觉模拟评分以及西安大略和麦克马斯特大学骨关节炎指数评分中的疼痛减轻。使用这种技术进行膝神经冷冻射频消融可能有助于减少辐射暴露，尤其是在经验有限的新手医生进行该手术时。
