University of Pennsylvania
Patient with atraumatic knee pain without a large knee effusion on x-ray will be randomized to receive either a genicular nerve block (GNB) or standard of care in the emergency department.
Inclusion Criteria: * Atraumatic knee pain * \>17 years age * X-ray of the knee obtained in the ED * Initial pain score (numeric rating scale) 5-10 Exclusion Criteria: * Fracture or dislocation on x-ray * large knee joint effusion identified on x-ray * allergy or contraindication to local anesthetics * History of local anesthetic systemic toxicity after receiving local anesthetics * Pregnancy * Incarcerated * History of knee replacement of affected knee * Concern for septic joint * Overlying cellulitis * Hemodynamic instability * Altered mental status or inability to consent for procedure.
genicular nerve block with ideal body-weight dosing of bupivacaine 0.5% with 4 mg dexamethasone
This involves standard of care pain relief for patients who do not receive the genicular nerve block for knee pain, such as acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs), and opioids.
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