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Abstract
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Background and Aims Genicular nerve block is defined as infiltration of the sensory branches innervating knee joint before they enter knee capsule. Inconsistency in the terminology and origin of genicular nerves in the literature may be related to variations in anatomical descriptions. Aim of this study was to provide the dissection of genicular nerves and to evaluate efficacy in postoperative analgesia in arthroscopic anterior cruciate ligament(ACL) repair by ultrasound guided blocking of identifiable nerves.
Methods In the first phase, four cadaveric knees were dissected. N.obturatorius, n.ischiadicus, n.peroneus communis and n.tibialis branches were found. Genicular nerves of knee capsule were demonstrated. In the second stage, 60 patients aged 18-75 years who were planned for ACL operation were randomly divided into two equal groups. Group G; preoperative genicular block was applied from four different injection points, while Group K received no block. All patients were operated under general anesthesia. Postoperative fentanyl IV patient-controlled analgesia was administered. Postoperative VAS scores at rest and motion, analgesic drug consumption and side effects were measured at 1-6-12-24 hours.
Results Superior medial and lateral genicular branches originated from n. tibialis, inferior lateral branches originated from n. peroneus communis, inferior medial branches originated from n. tibialis and branches originated from n. saphenus participated in sensory innervation. In our study, additional analgesic was required in Group K at 1-6-24 hours. Postoperative VAS values were lower in Group G at all times.
Ultrasound guided genicular nerve blocks
Anatomical dissection of superior medial genicular nerve
Anatomical dissection of superior lateral genicular nerve
Conclusions Knee capsule has a very rich nerve network. Genicular block should be considered as a good postoperative analgesia option after ACL repair surgery.