• Yian Chen, VuTo-Nhu HTHAnesthesiology & Perioperative Medicine, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, USA tonhuvu@pennstatehealth.psu.edu., Vernon M Chinchilli, Mohamed Farrag, Alexandra R Roybal, Albert Huh, Zared O Cohen, Adam B Becker, Babak Arvanaghi, Mrinal Agrawal, Jacob Ogden, and Steven P Cohen.
• Anesthesiology and Critical Care Medicine, Stanford University School of Medicine, Stanford, California, USA.
• Reg Anesth Pain Med. 2021 Apr 1; 46 (4): 298-304.

BackgroundThere has been a surge in interest in radiofrequency ablation (RFA) of the genicular nerves over the past decade, with wide variability in selection, technique and outcomes. The aim of this study is to determine factors associated with treatment outcome.MethodsWe retrospectively evaluated the effect of 23 demographic, clinical and technical variables on outcomes in 265 patients who underwent genicular nerve RFA for knee pain at 2 civilian and 1 military hospital. A primary outcome was designated as a > 30% decrease in average knee pain score lasting at least 3 months without cointerventions.ResultsThe overall rate of a positive response was 61.1% (95% CI 55.2% to 67.0%). In univariable analysis, larger electrode size (p=0.01), repeated lesions (p=0.02), having>80% pain relief during the prognostic block (p=0.02), not being on opioids (p=0.04), having no coexisting psychiatric condition (p=0.02), having a lower baseline pain score (p=0.01) and having >3 nerves targeted (p=0.02) were associated with a positive outcome. In multivariate logistic analysis, being obese (OR 3.68, 95% CI 1.66 to 8.19, p=0.001), not using opioids (OR 0.35, 95% CI 0.16 to 0.77, p=0.009), not being depressed (OR 0.29, 95% CI 0.10 to 0.82, p=0.02), use of cooled RFA (OR 3.88, 95% CI 1.63 to 9.23, p=0.002) and performing multiple lesions at each neural target (OR 15.88, 95% CI 4.24 to 59.50, p<0.001) were associated with positive outcome.ConclusionsWe identified multiple clinical and technical factors associated with treatment outcome, which should be considered when selecting patients for RFA treatment and in the design of clinical trials.© American Society of Regional Anesthesia & Pain Medicine 2021. No commercial re-use. See rights and permissions. Published by BMJ.

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