Perioperative Anterior Knee Pain Management and Ultrasound-Guided Genicular Nerve Block: a Narrative Review

Purpose of Review The comprehensive management of acute anterior knee pain is still challenging despite all the ongoing research and debate. With the goal of providing adequate motor-sparing analgesia after knee surgery, ultrasound-guided genicular nerve blocks, which directly target articular branches of the nerves that innervate the capsule of the knee, have now emerged as a promising new regional anesthesia technique. A literature search was conducted to describe anatomical considerations of the innervation to the anterior knee capsule, the ultrasound techniques to view this innervation, and a summation of the current evidence to provide analgesia in the setting of chronic and acute pain management. Recent Findings Studies in chronic pain patients, as well as emerging evidence in the perioperative literature, are favorable to the addition of ultrasound-guided genicular blocks to our armamentarium for the treatment of acute knee pain in the surgical setting. However, discerning their exact efficacy and their ideal implementation in the context of our current motor-sparing multimodal analgesia regimens, clinical pathways, and enhanced recovery after surgery protocols remains unclear due to the limited body of high-quality evidence to date. Summary Ultrasound-guided genicular nerve block (US-GNB) is a selective, motor-sparing nerve block with limited but favorable efficacy and safety profiles to date, which could become a valuable addition to our current knee surgery pain protocols. More research is needed to elicit the techniques that provide the most optimal anatomical coverage and discover the best clinical pathways in order to improve the efficacy and quality of perioperative anterior knee pain management.