RT Journal Article SR Electronic T1 Accuracy of fluoroscopic-guided genicular nerve blockade: a need for revisiting anatomical landmarks JF Regional Anesthesia & Pain Medicine JO Reg Anesth Pain Med FD BMJ Publishing Group Ltd SP 950 OP 958 DO 10.1136/rapm-2019-100451 VO 44 IS 10 A1 Loïc Fonkoue A1 Catherine Wydemans Behets A1 Arnaud Steyaert A1 Jean-Eric Kouame Kouassi A1 Christine Detrembleur A1 Bernard Le Polain De Waroux A1 Olivier Cornu YR 2019 UL http://rapm.bmj.com/content/44/10/950.abstract AB Background and objectives Genicular nerve blockade (GNB) and radiofrequency ablation (RFA) have recently emerged as treatment options for patients with chronic knee pain. However, an increasing number of anatomical studies and systematic reviews concluded that the anatomical basis for needle placement was unclear, incomplete and somewhat inaccurate. This study was designed to assess the accuracy of updated anatomical landmarks for fluoroscopy-guided blockade of the consistent genicular nerves in a cadaveric model.Methods Based on a comprehensive review of recent anatomical studies and prior dissection of 21 fresh cadaver knees, we defined bony landmarks with high likelihood of successful ablation of the five consistent genicular nerves (GN). We tested the accuracy of GNBs using the above-stated anatomical landmarks in 10 intact fresh cadaveric knees. Needle placement was guided by fluoroscopy and 0.5 mL of 0.1% methylene blue was injected at the site of each nerve. The knees were subsequently dissected to assess the accuracy of the injections. If the nerve was dyed with blue ink, the placement was considered accurate.Results The accuracy of our injections was 100% for the superior medial genicular nerve, inferior medial GN, infrapatellar branch of saphenous nerve and recurrent fibular nerve. The superior lateral GN was dyed in 90% of specimens.Conclusion This study provides physicians with precise anatomical landmarks for the five consistent GN for fluoroscopic-guided GNB. Our revised technique, which targets more nerves with increased accuracy, could potentially lead to improved therapeutic benefits on chronic knee pain.