A Prospective Randomized Trial of Prognostic Genicular Nerve Blocks to Determine the Predictive Value for the Outcome of Cooled Radiofrequency Ablation for Chronic Knee Pain Due to Osteoarthritis
A Prospective Randomized Trial of Prognostic Genicular Nerve Blocks to Determine the Predictive Value for the Outcome of Cooled Radiofrequency Ablation for Chronic Knee Pain Due to Osteoarthritis
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DOI：
10.1093/pm/pnx286
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发表时间：
2018-08-01
期刊：
影响因子：
3.1
通讯作者：
Walega, David R.
中科院分区：
文献类型：
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作者：
McCormick, Zachary L.;Reddy, Rajiv;Walega, David R.
背景和目标。膝神经射频消融术是治疗膝骨关节炎慢性疼痛的有效方法；然而，预测手术成功的因素知之甚少。本研究评估膝神经阻滞在预测膝神经冷却射频消融术（cRFA）治疗骨关节炎患者预后中的作用。这项随机对照试验包括由骨关节炎引起的慢性膝关节疼痛患者。参与者在cRFA前随机接受膝神经阻滞或不接受阻滞。接受预后阻滞且疼痛缓解>= 50%达6小时的患者接受cRFA治疗。主要结局是6个月时膝关节疼痛减轻50%的受试者比例。29名参与者（36个膝关节）在预后阻滞后出现了cRFA， 25名患者（35个膝关节）没有出现cRFA。预后阻滞组17名参与者（58.6%）和无阻滞组16名参与者（64.0%）在6个月时疼痛缓解>= 50% （P = 0.34）。西安大略省和麦克马斯特大学的骨关节炎指数在6个月时下降了15个点，预后阻滞组29人中有17人（55.2%），无阻滞组25人中有15人（60%）（P = 0.36）。该研究表明，cRFA后6个月疼痛和身体功能有临床意义的改善。在每个注射部位使用1mL局麻量的预后膝神经阻滞和>= 50%的疼痛缓解阈值对于随后的cRFA资格并没有提高治疗成功率。
Background and Objectives. Genicular nerve radiofrequency ablation is an effective treatment for patients with chronic pain due to knee osteoarthritis; however, little is known about factors that predict procedure success. The current study evaluated the utility of genicular nerve blocks to predict the outcome of genicular nerve cooled radiofrequency ablation (cRFA) in patients with osteoarthritis.Methods. This randomized comparative trial included patients with chronic knee pain due to osteoarthritis. Participants were randomized to receive a genicular nerve block or no block prior to cRFA. Patients receiving a prognostic block that demonstrated >= 50% pain relief for six hours received cRFA. The primary outcome was the proportion of participants with >= 50% reduction in knee pain at sixmonths.Results. Twenty-nine participants (36 knees) had cRFA following a prognostic block, and 25 patients (35 knees) had cRFA without a block. Seventeen participants (58.6%) in the prognostic block group and 16 (64.0%) in the no block group had >= 50% pain relief at six months (P = 0.34). A 15-point decrease in the Western Ontario and McMaster Universities Osteoarthritis Index at six months was present in 17 of 29 (55.2%) in the prognostic block group and 15 of 25 (60%) in the no block group (P = 0.36).Conclusions. This study demonstrated clinically meaningful improvements in pain and physical function up to six months following cRFA. A prognostic genicular nerve block using a local anesthetic volume of 1mL at each injection site and a threshold of >= 50% pain relief for subsequent cRFA eligibility did not improve the rate of treatment success.