Ultrasound Guided Genicular Nerve Blocks
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- Опубликовано: 8 сен 2024
- WE HAVE AN UPDATED GENICULAR BLOCKS VIDEO AS OF 3/2024. CHECK OUT THIS LINK TO VIEW IT:
• Ultrasound Guided Geni...
In this video we describe the rationale, anatomy and approach to ultrasound guided genicular nerve blocks as used in our multimodal analgesic pathway for total knee arthroplasty
You've made a big difference in my practice for outpatient ACLs.
Thank you!
Amazing. So much education in such little time!
I have just had TKA done June 7th of 2022, and I am amazed at how I never felt any bone pain or needed more than two days worth of opioids. I am walking unassisted 4days post-op. My question is: How long has Genicular nerve block anesthesia for TKA been available in Texas?
Thank you
I have one scheduled in a few weeks due to severe pain around the kneecap after sitting for less than 10 mins. My pain Mgr wants to do this before adjusting my meds. Will he hit all the areas you just described, and how effectively does it control pain in most patients?
Are there any recommendations for preventing pain secondary to tourniquet use on lower extremities for longer than expected total knee arthroplasties?
Great! Thanks
What benefit does the geniculate nerve blocks really add to a well placed adductor canal and IPACK block? Does the nerve block to the vastus intermedius cover superficial patella pain? That would be the most significant pain reduction for our outpatient totals if that is where it covers.
Thank you very much! Great work
How long on average does the pain relief typically last?
Great content. But question....so...adductor canal/ipack/genicular blocks and a spinal. In a thin patient how do u manage maxing out local dose? Dilute? That's also a lot of needle pokes (7) to sell a leery patient.
@@regionalanesthesiology 👍. Thanks for the response!
@@regionalanesthesiology We thought about implementing it at our hospital to improve total joint turnover - what solution do you guys use for your spinal?
Also, how do you guys manage time out for spinal anesthesia? We usually time out after confirming tray sterility, surgeon’s marking and availability. Do you wait until surgeon scrubs out of prior case?
I think they place the spinal first, and then do these blocks. Since they are not targeting a nerve plexus, they feel this is safe. The staffing and physical space allows for this type of workflow. I don't think most places would be able to do it like this.
In thinner patients, lower your local concentration. Do spinal first, then blocks. This way the blocks are not painful. Explain to the patient that the subarachnoidal block is slightly less painful than venous cannulation while the blocks will not be painful due to the spinal. Use a separate space to do this to preserve work flow. If you are from a small regional hospital, where practice has been set in stone since the dawn of humanity, you need to be extra stubborn to make this work. If you are self tought in regional anesthesia make damn sure you've done your homework before performing a block (patient positioning, ultrasound use and ergonomics, medication, etc.).
So frustrating. Insurance has OK d it and doc is ready to go but somewhere in between it gets kicked back as not covered? Hope all are well and Merry Christmas. Joy came to fulfill hope
That’s frustrating-I’m sorry to hear that. I hope that gets sorted out soon. Merry Christmas to you and good luck!
Would a high volume adductor canal block, with, say 30mL of 0,5% ropivacaine, block genicular nerves by spreading posteriorly via adductor canal?
No. High volume + high pressure can and does migrate to the popliteal fossa mimicking an Ipack but it will not block genicular nerves. Or nerve to VI or VL for that matter.
Any tips for blocking genicular nerves in a patient who's thigh is thicker than my waist?
Do it under fluoroscopy
what if we do popliteal block instead of genicular, that is, popliteal block + femoral block for postop TKA analgesia? what do you think? can those who have an idea share?there are too many injections in genicular
That would work for pain, but you have foot drop (from popliteal block) and quadraceps weakness (from femoral block.) They did this commonly a while back (more than 10 years) but these more modern blocks (adductor, IPACK and genicular) are attempting to preserve strength to facilitate early mobilization (even same day discharge.)
Do you do these blocks Preop or postop? Post can be challenging since the dressing will be covering most of the area....
@@regionalanesthesiology How long do you find it takes you to perform all of those blocks? Is it multiple people performing them?
Subarachnoidal block first, unless contraindicated, using 2mL 0,5% isobaric bupivacaine, combined with 0,1mg of morphine sulphate. After spinal, do the blocks. In addition to adding dexamethasone to the mix, add 10-30mcg of dexmedetomidine to each 20mL syringe of local used for blocks. This will extend the duration of the blocks beyond 32 hours.
Any side effects sir ,this technique
IT DIDNT WORK FOR ME
Did you go potty? Number 1 or number 2? Listen: what did the cat 🐈⬛ say to the vacuum cleaner? “You suck!”