Optimizing Genicular Nerve Blocks and Phenol for Knee Pain- Journal Club

Podcast Show Notes

Episode Title: Optimizing Genicular Nerve Chemical Ablation: Insights from Dr. David Rosenblum

Episode Summary:

In this episode, we are joined by Dr. David Rosenblum, a New York-based interventional pain physician, who discusses optimizing genicular nerve chemical ablation. Dr. Rosenblum shares insights as well as his upcoming ultrasound course schedyke in New York City, focusing on regional anesthesia, interventional pain, and IV ultrasound placement. He emphasizes the significance of ultrasound in enhancing pain management procedures and the latest advancements in the field.

Key Topics Discussed:

• Overview of Dr. Rosenblum's upcoming ultrasound courses in NYC, including regional anesthesia and IV ultrasound placement. More information can be found here or at NRAPpain.org.
• The role of ultrasound in interventional pain management, specifically in optimizing genicular nerve chemical ablation.
• Discussion on the recent study comparing genicular nerve phenol neurolysis and radiofrequency ablation.
• Importance of updating anatomical targets for pain management.
• Recommendations for expanding the number of targets in pain interventions.
• Insights on the safety and efficacy of chemical neurolysis versus radiofrequency procedures.
• Challenges and considerations in performing neurolytic blocks.
• Future directions in personalized treatment for chronic pain patients.

For Anesthesia Board Prep go to AnesthesiaExam at NRAPpain.org

Featured Article:

Dr. Rosenblum references an article from The Korean Journal of Pain discussing the optimization of genicular nerve chemical ablation. Key takeaways include:

• The evolution of anatomical understanding related to genicular nerves.
• The recommendation to consider multiple targets for pain management instead of the traditional three.
• The need for careful patient examination to map pain effectively before intervention.

• Discussion on Knee Pain Management

  • ArticlebyAndresRochaRomero:
  • Discussion on knee pain targeting genicular nerve ablation.
  • Co-authored by Tony Ng and King K Stanley Lam.
  • Published in Korean Journal of Pain.
  • Highlights differences in pain management practices outside the U.S.

  Other Points on Genicular Nerve Chemical Ablation discussed

  • Phenol ablation being used more internationally vs. radiofrequency ablations.

  • Considerations for more extensive targeting of genicular nerves:
    • Importance of the median branch of the nerve to the vastus intermedius. • Expansion of targeting to include 6 nerves, not just 3.
    • Anatomical variations require different approaches.

    Recommendations and Observations

    • Importance of considering patient-specific anatomy and pain. • Repeat procedures and rehabilitation:

    • Concerns about bio intensity and fascia integrity.
    • Emphasizes muscle strengthening exercises to support knee.

  • CRPS Considerations:
  • Elderly patients may develop CRPS post-knee replacement.
  • Importance of lumbar sympathetic block in diagnosis and treatment.

Host Bio:

Dr. David Rosenblu