Ultrasound Guided Genicular Blocks (2024 update!)

In this video, we outline the step-by-step method to block ALL of the genicular nerves for acute or chronic knee pain. We'll combine these with one or more of these complementary blocks:
Femoral Nerve Block: • Femoral and lateral fe...
Adductor Canal Block: • Adductor Canal Block (...
iPACK Block: • iPACK Block (Interspac...

[@Vilissimus]

Can't wait to tell my ortho bro "of course we can already start the surgery. Just let me do my 9 regional anesthesia injections real quick"

[@akshayjag117]

Just don't be slow

[@quro86]

If you never practice them, you will take a lot of time forever. I´ve heard some fellows with Dr Gadsden have a record of 9 minutes. Maybe realistically speaking 15-20 minutes could be very reasonable.

[@Vilissimus]

@@quro86 9 minutes for genicular+saphenous+ipack+cutaneus?
I usually have 15-20 minutes total for transition.

[@edwardherrera846]

I can do genicular, adductor, and iPACK in 10-12 mins realistically. And to do this you need an assistant and you need all your block needles and syringes loaded and ready to go. I start with patient lateral for iPACK, then supine for adductor and finish off supine for genicular (3 blocks).

[@campanova]

I can do them in 10-12 minutes

[@evilo720]

Thank you, Very clear !

[@elbekubaydullayev1126]

Thanks!

[@marcoantoniodiaz6612]

Excellent 👍🏼👍🏼👍🏼👍🏼👍🏼

[@user-pr1kf5mo9y]

Thank you so much for posting this, and promoting the inferolateral. Also has great application in ACL reconstruction. Appreciate your amazing videos!

[@adelemam8778]

Thank you for the great video. May I ask you how long do you take to block all of these together ( adductor, Ipack and geniculars)?

[@knowyourenemy50]

it's nice that all of these knee blocks can potentially provide maximal sensory analgesia with minimal motor blockade, but how many patients would realistically tolerate this many needle sticks? 1 for adductor + AFCN. 3 for genicular blocks. 1 for iPACK. so 5 separate needle sticks at least?

[@intestinomedicino]

I use them once spinal anesthesia has been applied or just before taking the patient to PACU; if under GA just after intubation or before waking up the patient, it all depends of how much time the surgeon leaves me alone doing my job; so far haven't have no single "ouch" from that many punctures.

[@regionalanesthesiology]

Thanks for the questions--yes, it can be a number of pokes. The geniculars especially can be a little uncomfortable when the needle hits the periosteum, but a little sedation/analgesia goes a long way. I personally like to do my spinal FIRST in preop, then immediately do the adductor, ipack and genics (I'm also now doing anterior femoral cutaneous nerve blocks too for the skin). The whole thing (spinal plus blocks) can be done in less than 10-15 min once you're up to speed, and well tolerated after the spinal goes in. We had to get our preop nurses comfortable with the idea of a patient getting a spinal out of the OR, but were able to show them it's safe and effective. Good luck!

[@user-rn7fw2pe1d]

Tell ortho bro how would he like his mom taken care of and while you wait for his response, your blocks will be done. These take 2 minutes max.

[@rayclark474]

What is the 6 month pain reduction rate? I deal with intense pain minutes after I sit down for class and I have 2 80 minute classes back to back. Standing up is a challenge. Thanks

[@dr6627]

are you still doing the anterior cutaneous nerve blocks?

[@teely16]

Can we replace adductor canal with this block? The articular branches of adductor canal seems to land on the same place as injections for this? I suppose with addition of nerve to vastus intermedius?

[@ankuryadav7328]

Why not use an epidural catheter and be done with it?

[@onurkumcu5462]

to avoid motor blockade caused by epidural

[@SamtaniPradeep]

How will this block be providing postoperative analgesia Sir as postoperative knee is now a metallic implant now?? And metallic implant has got no innervation Sir