# Effect of ultrasound-guided genicular nerve neurolysis versus sham procedure on pain in patients with knee osteoarthritis: a randomized clinical trial

## TL;DR

This study shows that a minimally invasive nerve treatment using ultrasound guidance significantly reduces knee osteoarthritis pain and opioid use in older adults.

## Contribution

The study provides clinical evidence that ultrasound-guided genicular nerve neurolysis with ethanol is a safe and effective treatment for knee osteoarthritis pain.

## Key findings

- Ultrasound-guided neurolysis reduced pain intensity at all follow-up points compared to a sham procedure.
- The treatment significantly decreased opioid consumption and improved quality of life over six months.
- No neurological complications or serious adverse events were observed in either group.

## Abstract

Knee osteoarthritis (OA) is a prevalent and disabling condition, especially in older adults. For patients who are not candidates for total knee arthroplasty (TKA) due to comorbidities or limited access to care, minimally invasive pain-relief options are critically needed.

To assess the efficacy and safety of ultrasound-guided chemical neurolysis using 95% ethanol targeting four genicular nerves in patients with symptomatic knee OA who have not responded to conservative management.

Double-blind, randomized, sham-controlled clinical trial.

A total of 100 adults with symptomatic knee OA, confirmed radiographically and unresponsive to conservative treatment, were enrolled and randomized.

Patients were randomized to receive ultrasound-guided chemical neurolysis of the superomedial, superolateral, recurrent tibial, and inferomedial genicular nerves with 95% ethanol (treatment group) or a sham procedure (control group).

The primary outcome was pain intensity measured by the Numerical Rating Scale (NRS) at 7 days, 30 days, 3 months, and 6 months post-procedure. Secondary outcomes included opioid consumption and health-related quality of life measured by the EQ-5D-5L questionnaire. Safety outcomes focused on the occurrence of neurological complications. Analyses were conducted using an intention-to-treat approach with appropriate handling of missing data.

Patients in the ethanol neurolysis group experienced significantly greater reductions in NRS scores at all follow-up points compared to the sham group (P < .0001). Opioid consumption was also significantly reduced in the neurolysis group throughout the 6-month period (P < .0001). Quality of life, as assessed by EQ-5D-5L, improved significantly in the treatment group (P < .0001). No neurological deficits or serious adverse events were reported in either group.

Ultrasound-guided chemical neurolysis of the SMGN, SLGN, RTGN, and IMGN with 95% ethanol is a safe and effective minimally invasive treatment for patients with refractory knee OA pain. It significantly reduces pain and opioid use while improving quality of life, making it a valuable therapeutic option for individuals ineligible for surgical intervention.

This double-blind, randomized controlled trial evaluates the efficacy and safety of ultrasound-guided genicular nerve neurolysis using 95% ethanol in elderly patients with knee osteoarthritis. The intervention significantly reduced pain intensity and opioid use and improved quality of life compared to a sham procedure. No neurological complications were observed. Findings support this minimally invasive technique as a safe and cost-effective alternative for patients ineligible for surgery.