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      Comparison of Genicular Nerve Block in Combination With Adductor Canal Block in Both Primary and Revision Total Knee Arthroplasty: A Retrospective Case Series

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          Abstract

          The management of pain in patients undergoing total knee arthroplasty (TKA) for chronic knee osteoarthritis (OA) has remained a challenge for the anesthesiologist regarding regional anesthesia as no single regional technique is adequate with regard to balancing effective analgesia with minimal muscle weakness. Severe postoperative pain following TKA has been shown to negatively impact patient outcomes and mortality. The genicular nerve block has recently been demonstrated to provide effective analgesia to the anterior and posterior knee capsule in recent studies. In this retrospective case series, we compare the efficacy of combined genicular nerve block (GNB) and adductor canal block (ACB) to only ACB in both primary and revision TKA patients. This combined novel approach for TKA patients can be utilized to improve patient pain scores and early ambulation, limiting the use of opioids and early discharge.

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          Knee osteoarthritis has doubled in prevalence since the mid-20th century

          Ian Wallace, Steven Worthington, David T Felson … (2017)
          Knee osteoarthritis is a highly prevalent, disabling joint disease with causes that remain poorly understood but are commonly attributed to aging and obesity. To gain insight into the etiology of knee osteoarthritis, this study traces long-term trends in the disease in the United States using large skeletal samples spanning from prehistoric times to the present. We show that knee osteoarthritis long existed at low frequencies, but since the mid-20th century, the disease has doubled in prevalence. Our analyses contradict the view that the recent surge in knee osteoarthritis occurred simply because people live longer and are more commonly obese. Instead, our results highlight the need to study additional, likely preventable risk factors that have become ubiquitous within the last half-century. Knee osteoarthritis (OA) is believed to be highly prevalent today because of recent increases in life expectancy and body mass index (BMI), but this assumption has not been tested using long-term historical or evolutionary data. We analyzed long-term trends in knee OA prevalence in the United States using cadaver-derived skeletons of people aged ≥50 y whose BMI at death was documented and who lived during the early industrial era (1800s to early 1900s; n = 1,581) and the modern postindustrial era (late 1900s to early 2000s; n = 819). Knee OA among individuals estimated to be ≥50 y old was also assessed in archeologically derived skeletons of prehistoric hunter-gatherers and early farmers (6000–300 B.P.; n = 176). OA was diagnosed based on the presence of eburnation (polish from bone-on-bone contact). Overall, knee OA prevalence was found to be 16% among the postindustrial sample but only 6% and 8% among the early industrial and prehistoric samples, respectively. After controlling for age, BMI, and other variables, knee OA prevalence was 2.1-fold higher (95% confidence interval, 1.5–3.1) in the postindustrial sample than in the early industrial sample. Our results indicate that increases in longevity and BMI are insufficient to explain the approximate doubling of knee OA prevalence that has occurred in the United States since the mid-20th century. Knee OA is thus more preventable than is commonly assumed, but prevention will require research on additional independent risk factors that either arose or have become amplified in the postindustrial era.
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            Estimating the burden of total knee replacement in the United States.

            Alexander Weinstein, Benjamin N Rome, William Reichmann … (2013)
            In the last decade, the number of total knee replacements performed annually in the United States has doubled, with disproportionate increases among younger adults. While total knee replacement is a highly effective treatment for end-stage knee osteoarthritis, total knee replacement recipients can experience persistent pain and severe complications. We are aware of no current estimates of the prevalence of total knee replacement among adults in the U.S.
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              Radiofrequency treatment relieves chronic knee osteoarthritis pain: a double-blind randomized controlled trial.

              Seong-Woo Choi, Yong-Kook Kang, Jung Hwan Park … (2011)
              Chronic osteoarthritis (OA) pain of the knee is often not effectively managed with current non-pharmacological or pharmacological treatments. Radiofrequency (RF) neurotomy is a therapeutic alternative for chronic pain. We investigated whether RF neurotomy applied to articular nerve branches (genicular nerves) was effective in relieving chronic OA knee joint pain. The study involved 38 elderly patients with (a) severe knee OA pain lasting more than 3 months, (b) positive response to a diagnostic genicular nerve block and (c) no response to conservative treatments. Patients were randomly assigned to receive percutaneous RF genicular neurotomy under fluoroscopic guidance (RF group; n=19) or the same procedure without effective neurotomy (control group; n=19). Visual analogue scale (VAS), Oxford knee scores, and global perceived effect on a 7-point scale were measured at baseline and at 1, 4, and 12weeks post-procedure. VAS scores showed that the RF group had less knee joint pain at 4 (p<0.001) and 12 (p<0.001) weeks compared with the control group. Oxford knee scores showed similar findings (p<0.001). In the RF group, 10/17 (59%), 11/17 (65%) and 10/17 (59%) achieved at least 50% knee pain relief at 1, 4, and 12 weeks, respectively. No patient reported a post-procedure adverse event during the follow-up period. RF neurotomy of genicular nerves leads to significant pain reduction and functional improvement in a subset of elderly chronic knee OA pain, and thus may be an effective treatment in such cases. Further trials with larger sample size and longer follow-up are warranted. Copyright © 2010 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Cureus
                Journal ID (iso-abbrev): Cureus
                Journal ID (issn): 2168-8184
                Title: Cureus
                Publisher: Cureus (Palo Alto (CA) )
                ISSN (Electronic): 2168-8184
                Publication date (Electronic, pub): 29 July 2021
                Publication date (Electronic, collection): July 2021
                Volume: 13
                Issue: 7
                Electronic Location Identifier: e16712
                Affiliations
                [1 ] Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, USA
                [2 ] Medicine, Edward Via College of Osteopathic Medicine, Birmingham, USA
                [3 ] Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, USA
                [4 ] Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, USA
                Author notes
                Article
                DOI: 10.7759/cureus.16712
                PMC ID: 8399964
                PubMed ID: 34471571
                SO-VID: b449aa65-2427-47f9-8b4f-1de7a429ef30
                Copyright © Copyright © 2021, Kukreja et al.
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date accepted : 28 July 2021
                Categories
                Subject: Anesthesiology
                Subject: Pain Management
                Subject: Orthopedics

                Keywords: total knee arthroplasty,post-operative analgesia,adductor canal block,genicular nerve block,oral morphine equivalents
                Data availability:
                Keywords: total knee arthroplasty, post-operative analgesia, adductor canal block, genicular nerve block, oral morphine equivalents

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