Three Needles Approach-A New Technique of Genicular Nerves Radiofrequency Ablation for Pain Relief in Advanced Chronic Knee Osteoarthritis: A Randomized Trial.

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BACKGROUND: Ablation of the genicular nerves (GN) has emerged as a useful alternative therapeutic modality in chronic knee osteoarthritis (OA) specially for high-risk patients. However, in some cases due to the presence of other articular branches or anatomical variability, it may have a poor impact in relieving pain. Ablation of other or additional articular branches might have different outcomes. OBJECTIVES: We aimed to investigate the efficacy and safety of using 3 needles as a new technique in ablation of GN and compare it to the classic single-needle approach. STUDY DESIGN: A prospective parallel single-blind randomized study. SETTING: Department of Anesthesia and Intensive Care, Faculty of Medicine, Minia University, Egypt, and Pain Management Unit, Assiut University Hospital, Egypt. METHODS: Fifty patients with advanced knee OA were involved in this clinical study to be treated with radiofrequency ablation of GN using either: the single-needle technique (SN group [n = 25]) or the 3-needle technique (TN group [no = 25]) and assessed for: pain with the Visual Analog Scale (VAS); knee function and disability with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC); and patient satisfaction using global-perceived effect throughout 2 weeks, and 1, 3, and 6 months after the procedure. RESULTS: Significantly longer and better improvement in perceived pain (VAS), function and disability (WOMAC) with more patients' satisfaction were recorded in the TN group than the SN group at all follow-up time points without untoward events. LIMITATIONS: Short follow-up time; longer period could permit recognition of long-term outcome. CONCLUSIONS: Compared to the conventional single-needle GN ablation technique, the 3-needle approach appears to be a promising, safe, and more effective ablation technique for patients with chronic knee OA.

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