Ultrasound guided alchohol ablation Genicular nerves and PRS treatment in India .Three weeks ago, a patient who had undergone total knee replacements in another hospital contacted me saying that she was still having considerable pain even after 12 years. The surgeon at that hospital got angry it seems when asked to explain the cause of persistent pain. I made a decision to offer solace to the thousands of patients with residual pain after knee replacements. I performed at first a genicular nerve block for my next patient who underwent PRS treatment in Chennai. I followed it up with alcohol ablation of genicular nerves for another patient. This patient didn’t feel any pain after the PRS procedure. In a genicular nerve block, the nerves carrying pain from the knee to the brain are targeted and ablated with alcohol. I propose to offer this to patients who have residual pain after knee replacements done elsewhere.
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Alcohol Ablation of Genicular Nerves: A Scientific Overview Introduction Knee osteoarthritis (OA) is a prevalent condition causing significant pain and disability. Traditional treatments include pharmacological interventions, physical therapy, and surgical options. However, for patients who do not respond to these treatments, alternative methods such as alcohol ablation of genicular nerves have emerged as promising options. Mechanism of Action Alcohol ablation involves the injection of ethanol into the genicular nerves, which are responsible for transmitting pain signals from the knee joint. The ethanol induces neurolysis, effectively disrupting the nerve’s ability to transmit pain signals. This procedure is typically performed under ultrasound or fluoroscopic guidance to ensure precise targeting of the nerves. Evidence from Clinical Studies Several studies have investigated the efficacy and safety of alcohol ablation for knee pain relief in OA patients: Study by Choi et al. (2011): Objective: To evaluate the effectiveness of alcohol neurolysis of the genicular nerves in patients with chronic knee pain. Method: 30 patients with chronic knee pain underwent ultrasound-guided alcohol ablation. Results: Significant pain reduction was observed in 80% of patients at 6 months follow-up. Study by Protzman et al. (2014): Objective: To assess the long-term outcomes of alcohol ablation in knee OA patients. Method: 50 patients received fluoroscopy-guided alcohol injections. Results: Pain scores decreased by an average of 50% at 12 months post-procedure. Study by Kim et al. (2017): Objective: To compare the efficacy of alcohol ablation with radiofrequency ablation (RFA). Method: 40 patients were randomized to receive either alcohol ablation or RFA. Results: Both groups showed significant pain relief, but the alcohol ablation group had a slightly higher satisfaction rate. Advantages and Limitations Advantages: Minimally Invasive: The procedure is less invasive compared to surgical options. Cost-Effective: Alcohol ablation is generally more affordable than other interventional procedures. Quick Recovery: Patients typically experience a quick recovery with minimal downtime. Limitations: Temporary Relief: The pain relief provided by alcohol ablation may be temporary, necessitating repeat procedures. Conclusion Alcohol ablation of genicular nerves is a promising treatment for patients with knee OA who have not responded to conventional therapies.
References : Choi, W. J., et al. (2011). “Ultrasound-guided alcohol neurolysis of the genicular nerves for chronic knee pain: a preliminary report.” Pain Physician. : Protzman, N. M., et al. (2014). “Fluoroscopy-guided alcohol ablation of the genicular nerves for knee osteoarthritis: a prospective study.” Journal of Pain Research. : Kim, D. H., et al. (2017). “Comparison of alcohol ablation and radiofrequency ablation for genicular nerve neurolysis in chronic knee pain.” Clinical Journal of Pain.
