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Old 10-30-2012, 07:26 AM
cathy56 cathy56 is offline
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Default Genicular nerve block

Hi all,

I hope someone can help with this op-note.

The patient was brought to the operating room and placed in the supine position on the x-ray
table. The patient’s knee was then placed on pillows as tolerated to offset a clear lateral view of
each leg. The skin of the target knee was prepped with a Betadine solution as well as sterile prep
sticks. On the affected knee the superior medial and lateral epicondyle of the femur as well as the
distal aspect of the medial tibial epicondyle was identified as the target zone for the injection
using an AP view. Each of these regions was marked and the skin and subcutaneous tissue of
these regions were infiltrated with several mLs of local anesthesia prior to inserting a 22 gauge
spinal needle. The needles were advanced using fluoroscopic guidance until reaching the mid
level of the femur and tibia confirmed with a lateral view. 0.5 mL of dye was injected at each of
the nerve sites after negative aspiration for air or heme to ensure the needle tip positioning.
Again, after negative aspiration for air or heme, 1 mL of a solution containing 0.25% bupivacaine
and 40 mg of Kenalog was injected at each of the sites. Sterile dressings were then put in place
on the patient to be kept intact for 48 hours. The patient tolerated the procedure well and was
transferred to the recovery room in stable condition.

I beleive its 64450 but not sure if it's one, two or three injections.
Any advice or guidance will be appreciated

Thank you
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Old 10-30-2012, 03:40 PM
Michele Hannon's Avatar
Michele Hannon Michele Hannon is offline
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It would appear there were three areas of interest.....superior medial epicondyle of the femur, superior lateral epicondyle of the femur and the distal medial epicondyle of the tibia.

I would query your physician for clarification and perhaps use it as a teaching point and ask him to help you understand what branches of the genicular he was treating.

Good luck
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Old 11-08-2012, 06:51 AM
cathy56 cathy56 is offline
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Thank you for your suggestion and taking the time to respond.

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