Genicular Blocks

What Are Genicular Blocks?

Genicular nerve blocks can be performed under fluoroscopic or ultrasound guidance. Nerves are targeted adjacent to the periosteum on the medial aspect of the tibia, and at both the medial and lateral aspects of the femur at the junctions of the shaft and the epicondyle.

Under fluoroscopic guidance, the provider will approach the target by introducing a spinal needle from either an anteroposterior or lateral entry point with the final position residing adjacent to the bone. After negative aspiration, some physicians elect to administer contrast to exclude vascular uptake, avoiding a false negative result. To conclude the procedure, 2 mL of local anesthetic is deposited on each of the superolateral, superomedial and inferomedial genicular nerves.

The most common risks associated with genicular nerve block are:

  • Misplacement of the needle.
  • Unexpected bleeding.
  • Drug allergy.
  • Infection.
  • Nerve damage.
  • Worsening pain.