The cardinal genicular nerves are named for their position relative to the knee joint: the superomedial genicular nerve (SMGN), the superolateral genicular nerve (SLGN), and the inferomedial (IMGN) and inferolateral (ILGN) genicular nerves. The anterior knee joint and capsule are supplied by four branches of the femoral nerve (the saphenous nerve and articular branches of the nerves to the three vasti), as well as multiple branches from the sciatic nerve. The posterior knee is innervated largely by the popliteal plexus, derived from the tibial and obturator nerves. AnatomyĪn overview of knee innervation is presented in Figure 1. 3 Recently, it was shown that the addition of genicular nerve blockade for TKA patients can significantly reduce postoperative opioid requirement, 4 and since these blocks are simple and quick to perform, they are an impactful addition to our block pathway for knee arthroplasty patients. Targeted genicular nerve blocks (or ablative procedures) have been a standard chronic pain intervention for arthritic pain in the past. Only two of these nerves (the saphenous and nerve to vastus medialis) are covered by a standard adductor canal block. This is not surprising, as the anterior knee is innervated by the saphenous nerve, articular branches of the nerves to the three vastus muscles (medialis, intermedius, and lateralis), and at least four genicular nerves. 1,2 However, many patients continue to experience significant pain after TKA, even when these two blocks are performed. Targeted, motor-sparing regional techniques such as adductor canal blocks and posterior capsule infiltration (aka IPACK) provide good pain control while facilitating early ambulation and rehab. Regional analgesia is a foundational component of multimodal postoperative pain management following knee replacement surgery (TKA). How I do it: genicular nerve blocks for acute pain. It does not store any personal data.Cite as: Dunworth S, Gadsden J. The cookie is set by the GDPR Cookie Consent plugin and is used to store whether or not user has consented to the use of cookies. The cookie is used to store the user consent for the cookies in the category 'Performance'. This cookie is set by GDPR Cookie Consent plugin. The cookie is used to store the user consent for the cookies in the category 'Other.

The cookies is used to store the user consent for the cookies in the category 'Necessary'. The cookie is set by GDPR cookie consent to record the user consent for the cookies in the category 'Functional'. The cookie is used to store the user consent for the cookies in the category 'Analytics'. These cookies ensure basic functionalities and security features of the website, anonymously. Necessary cookies are absolutely essential for the website to function properly. Watch this webinar to learn how using wireless ultrasound can help you perform quicker, safer procedures with less guesswork, and in many cases less anesthetic for more effective blocks.

It should help anyone’s confidence in what they’re doing to be able to see what they’re doing.” Hickman shares the advantages of wireless ultrasound for regional anesthesiology, “It improves your speed of being able to do the block, and it actually improves the duration of block because you’re getting more local around the target nerve versus doing it blind where you really don’t see it. Hickman shares his techniques for using high-resolution wireless ultrasound to perform 3 different pre-op blocks quickly, accurately, and efficiently to deliver maximum pain management for ACL repair surgery.ĭr. Depending on the surgery being performed and rehabilitation that follows, only select nerves need to be blocked, while and others avoided.

Innervation of the knee joint and surrounding tissues is complex. High-resolution ultrasound has proven invaluable in the precision and accuracy required to perform these blocks. An effective adductor canal block can actually facilitate post-operative rehab. Anesthesiologists work “behind the scenes” to ensure patients have minimal pain following knee surgeries, and at the same time ensuring sensory and motor function of the leg and foot is preserved. With an aging population, knee surgeries are now one of the most frequently performed procedures. Hickman as he shares video of an actual patient procedure, demonstrating how wireless ultrasound ensures excellent regional blocks for pain control immediately post-operatively and longer term if needed.

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Ipack block for knee arthroscopy