Ultrasound Pain Block Tip of the Week: How to identify the Genicular Nerves?

The genicular nerve block is indicated for chronic knee pain, total knee arthroplasty, or procedures associated with moderate to severe postoperative knee pain. 

Here are the ultimate scanning steps to identify each of the genicular nerves

• SLGN: Place the transducer in a coronal orientation over the lateral epicondyle of the femur and move proximally to visualize the metaphysis of the bone (A)
• SMGN: Place the transducer in a coronal orientation over the medial epicondyle of the femur and move slightly proximally to visualize the metaphysis of the bone just anterior to the adductor tubercle (B)
• ILGN: Place the transducer in a coronal orientation over the lateral side of the distal knee. After identifying the lateral epicondyle of the tibia, move the transducer distally to visualize the head of the fibula (C)
• IMGN: Place the transducer in a coronal orientation over the medial condyle of the tibia and move distally to visualize the metaphysis of the bone (D)

Sonoanatomy of the genicular nerves in a coronal plane. SLGA, superolateral genicular artery; SMGA, superomedial genicular artery; ILGA, inferolateral genicular artery; IMGA, inferomedial genicular artery

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