Pain Management Procedures
Genicular Nerve Block and RFA
Genicular Nerve Block and Radiofrequency Ablation
What are they?
Genicular nerves are small sensory branches around the knee. A genicular nerve block places local anesthetic near selected branches to see whether interrupting those signals reduces pain. If the test is clearly helpful, RFA may provide longer relief by heating a small section of each target nerve.
When may they be recommended?
These procedures may be considered for chronic knee pain from osteoarthritis when exercise, medication, and joint injections have not provided enough relief and surgery is not desired or appropriate. They may also be considered for persistent pain after total knee replacement, but the replacement should first be evaluated for infection, loosening, instability, or another correctable problem.
What happens?
You lie on your back with the knee supported. Fluoroscopy or ultrasound guides needles to bony landmarks around the knee. A diagnostic block uses a small amount of local anesthetic. During RFA, position is confirmed, the area is numbed, and controlled heat is applied through specialized needles.
What should I expect?
You can usually walk after a block, but should take it easy for the rest of the day. RFA soreness, bruising, or temporary numbness can occur. Benefit may take days to weeks and can last months. The nerves may recover over time.
Important risks
Risks include infection, bleeding, medication reaction, skin numbness, increased nerve pain, vascular injury, and uncommon injury to the common peroneal nerve that could cause foot weakness. RFA reduces pain signals; it does not repair arthritis or a mechanical problem with a knee replacement.
Preparing for your injection procedure…
Your instructions will depend on the procedure. Before any injection, tell the APG team if you:
Take aspirin, warfarin, clopidogrel, apixaban, rivaroxaban, or another medicine or supplement that affects bleeding. Never stop a prescribed blood thinner unless the clinician who manages it and the procedure team tell you how to do so safely.
Have diabetes, glaucoma, a bleeding disorder, an active infection, fever, or recent antibiotic treatment.
Could be pregnant, have an allergy to contrast dye or local anesthetic, or have reacted to steroid injections before.
Use an implanted pacemaker, defibrillator, spinal cord stimulator, or other electrical device.
Some procedures require fasting, a medication adjustment, or a responsible adult to drive you home, especially when sedation is planned. Follow the instructions provided for your specific appointment.
After your injection procedure…
Most injections are outpatient procedures. Mild soreness, bruising, temporary numbness, or a brief increase in the usual pain can occur. Follow the activity and bandage instructions you receive. Steroid medicine may take several days to have an effect and can temporarily raise blood sugar.
Call the office promptly for increasing redness, drainage, fever, severe or rapidly worsening pain, or new numbness or weakness. Seek emergency care for trouble breathing, chest pain, sudden loss of bladder or bowel control, a severe new headache, loss of vision, stroke-like symptoms, or rapidly progressing weakness.
This information is for general education and does not replace medical advice, diagnosis, or treatment. Not every procedure is appropriate for every patient, and results vary. Your APG care team will review your symptoms, examination, imaging, medical history, medications, and prior treatment before recommending a plan. Coverage requirements also vary by insurance plan.