An advanced block for chronic knee pain using ultrasound to identify vascular structures and, with higher frequency transducers, the nerves themselves. Inject the multiple branches of the genicular nerve under usual sterile technique all in one quick sitting under direct ultrasound guidance with usual sterile technique.
we're going to do a genicular nerve block there are three branches the superior medial superior lateral and inferior medial branch looking for the superior medial genicular nerve i scan the medial side of the knee putting on color doppler so scanning on the medial aspect of the knee we can find the genicular nerve running along with the artery close to the epicondyle take off the doppler and one can see the nerve next to the artery scanning distally the nerve approaches the corner of the epicondyle with the blood vessel as it descends to innervate the knee a little pinch okay causing one to two mls around the genicular nerve of the pivoting quarter percent now we're going to target the inferior branch of the medial genicular nerve going below the knee joint onto the tibia the medial aspect looking for the blood vessel it's a small nerve here may be difficult to find at times and it runs with a blood vessel and superficial to the bone it appears that the nerve is right here take off my doppler the pinch i'm injecting another one to two mls around the genicular nerve in the inferior medial position the bone over here is the tibia now we're going to scan for the lateral branch which also runs with a nerve which also runs with a blood vessel so i'm going to put my doppler on as i scan for the blood vessel to help me isolate the nerve and i like to go as distal as possible on the epicondyle as i'm scanning proximal to distal i'm looking for the nerve in the blood vessel too much pressure in the blood vessel will disappear so it's important not to press too hard i found the artery and the nerve is right under it there we go there's a picture of it and on top of the artery and i'm going to get the needle slightly lower so we have to tie the nerve underneath it there we go that's it that's the nerve right above my needle the arteries to the left of it much easier to see after the local anesthetic has been given this is the lateral genicular nerve one of the three branches that gives innervation to the knee joint you
