SIR 2024
Pain Management/MSK
Maryam Boumezrag, MD
PGY-5 Resident
Medstar Georgetown University Hospital
Financial relationships: Full list of relationships is listed on the CME information page.
John B. Smirniotopoulos, MD
Assistant Professor of Radiology
MedStar Georgetown University Hospital
Financial relationships: Full list of relationships is listed on the CME information page.
Ultrasound technique:
The superomedial, inferomedial, superolateral genicular neurovascular bundle are identified under ultrasound guidance. A small volume of 2% lidocaine is then administered at the skin. Under ultrasound guidance a 22-gauge spinal needles are advanced to the neurovascular bundle at each site. Aspiration was performed to ensure that needle positions are not intravascular in position. The neurolytic cocktail consisting of a combination of 99% dehydrated ethanol and 0.5% bupivacaine diluted to achieve 70% concentration of ethanol was then administered at each location in 1 cc aliquots
Fluoroscopic technique:
A radiopaque instrument is used to localize landmarks in a similar fashion to genicular nerve blocks targeting the superomedial, superolateral, inferolateral genicular nerves. Local anesthesia is administered with 1% lidocaine and 22-gauge spinal needles are advanced to the targeted site, with a depth of 60% femoral and tibial shaft diameter. Aspiration is performed to ensure the needles are not intravascular in location. A 1cc volume of neurolytic cocktail of 3:1 ethanol/bupivacaine mixture is administered at each location simultaneously to decrease discomfort.