Genicular Medial Branch RF Neurotomy

You will likely receive IV sedation for this procedure. A nurse will typically start an IV in the pre-op area prior to the procedure. You will then be accompanied into a sterile procedure suite, and asked to lie on the exam table. Using X-ray guidance, the doctor places a small needle near each genicular nerve. After the nerve is anesthetized with local anesthetic, an electrical current is used to create the ablation, or heat lesion. This nerve, once treated, will not be able to send as much of a pain signal to the brain as it did before, giving you relief of your chronic knee pain.

Following the injection, you will be cared for in the recovery area for a brief amount of time, and then discharged home.

If your procedure includes sedation

• You should have no solid foods for 8 hours before the procedure.
• You may have clear liquids up to 2 hours before your procedure. Examples of these clear liquids are:  water, broth, clear juices with NO pulp, tea, coffee WITHOUT cream. Carbonated beverages are NOT allowed.
• No gum chewing for 2 hours before your procedure.
• No candy, throat lozenges, or mints.
• A nurse will call you before your procedure to review your medications and make recommendations as to what medicines you should take before your procedure.

Failure to comply with these instructions may result in cancellation and rescheduling of your procedure.

Follow the specific instructions given to you by the nurses at the time of discharge from the recovery area:

• Do not drive or operate heavy machinery for 24 hours after your procedure, if you received sedation
• Resume activities as tolerated, understanding you may be sore for 7-10 days
• It is not uncommon for the patient to not experience relief of their chronic knee pain for up to 7-10 days after the procedure
• Do NOT soak in a bathtub or lake for 24 hours after the procedure. You may shower.
• You will receive a phone call from a clinic nurse, the following day to check in and see how you are recovering.

Radiofrequency ablation procedures are considered safe, non-surgical, minimally invasive treatments. As with all medical procedures, there are associated risks and side-effects that may vary between each patient. These rare but potential risks are:

• Pain at the injection site
• In very rare instances (less than 1%), minor infections can occur
• Increased pain or worsening symptoms.
• Post-ablation neuritis, which is an irritation of the nerves being targeted.
• Bleeding. Youmay suffer bleeding from undergoing procedures, especially while on blood thinning medications. Please notify us if you are taking any of the following blood thinning medications: Warfarin (Coumadin), Plavix (Clopidogrel), Aspirin, Xarelto (Rivaroxaban), Heparin, Lovenox (Enoxaparin), Brilinta (Ticagrelor), or any  others not listed.
• Allergic reactions to medications. The commonly used medications in this procedure include: Lidocaine, Bupivacaine, Ropivacaine, IV contrast dye, and corticosteroid (cortisone).
• Inability to complete the injection due to technical or anatomic difficulty.

Insurance companies have a series of requirements that must be met, prior to their approval of the radiofrequency ablation procedure. These may vary between insurance companies, however; they commonly include:

• Physical Therapy – often a minimum of 4 weeks in duration
• Completion of the genicular nerve block procedures with adequate relief for a minimum of 3 hours duration. Some insurance companies may require two diagnostic block procedures.