Ultrasound-guided pericapsular nerve group block and genicular nerve alcohol neurolysis in hip and knee pain due to osteoarthritis and following total joint replacement surgery: A preliminary study
Anna Udvarhelyi1
, Anett Kiss1, László Rudolf Hangody2, Olivér Domaraczki2, Viktor Mátyás2, Csaba Kopitkó1,3,4
1Department of Anesthesiology and Intensive Therapy, Uzsoki Street Teaching Hospital, Pain Clinic, Budapest, Hungary
2Department of Orthopedics and Traumatology, Uzsoki Street Teaching Hospital, Budapest, Hungary
3Department of Anesthesiology and Intensive Therapy, Dr. Kenessey Albert Hospital, Pain Clinic, Balassagyarmat, Hungary
4Department of Anesthesiology and Intensive Therapy, Hungarian Hospital of Defence Forces, Pain Clinic, Budapest, Hungary
Keywords: Ethyl alcohol, genicular, hip, knee, neurolysis, pericapsular nerve group block, PENG.
Abstract
Objectives: The aim of this study was to evaluate the efficacy of pericapsular nerve group block (PENG) and genicular neurolysis performed with ethyl alcohol in the management of pain associated with hip or knee osteoarthritis or persistent postoperative pain following arthroplasty.
Patients and methods: Between October 2023 and June 2024, a total of 89 ambulatory adult patients (70 males, 19 females; median age: 75.5 [IQR: 62.6 to 81.3] years; range: 46.7 to 92.8 years) who visited our pain clinic were retrospectively analyzed. The PENG or genicular nerve neurolysis was performed as appropriate using ethyl alcohol. Median and maximum level of pain according to patient self-report was registered before and after the interventions.
Results: A total of 33 patients presenting with hip pain and 56 patients presenting with knee pain were treated. Considering the reported median pain, the median intensity reduced from 7.5 to 3.5 for hip pain, whereas in the knee group the median intensity of pain was 7.0 before the intervention and 3.0 after the procedure. The median intensity of reported maximal pain reduced from 10 to 6.8 for the hip, and from 8.8 to 6.5 for the knee pain.
Conclusion: Alcoholic neurolysis offers a promising, cost-effective new approach for the management of pain in the absence of radiofrequency. It provides sustained pain relief until surgical arthroplasty of the hip or knee joint and is also beneficial in the management of persistent pain following surgery or for patients who are ineligible for surgical intervention.
Citation: Udvarhelyi A, Kiss A, Hangody LR, Domaraczki O, Mátyás V, Kopitkó C. Ultrasound-guided pericapsular nerve group block and genicular nerve alcohol neurolysis in hip and knee pain due to osteoarthritis and following total joint replacement surgery: A preliminary study. Jt Dis Relat Surg 2025;36(3):543-554. doi: 10.52312/ jdrs.2025.2179.
Study conception/design: A.U., A.K., C.S.K.; Patients’ selection: L.R.H., O.D., V.M.; Data acquisition/analysis/interpretation: A.U., A.K., C.S.K. Drafting/critical revising for important intellectual content: all authors. Approval of final version of paper: all authors. All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.
The authors received no financial support for the research and/or authorship of this article.
We sincerely appreciated the assistance of Ágnes Szekeres Pusztiné in creating the excellent Figures. We would like to express our gratitude to our colleagues working at the Chronic Pain Ambulance of the Hetényi Géza Hospital in Szolnok, where we were able to see the procedure for the first time and who then helped us with our further work.
The data that support the findings of this study are available from the corresponding author upon reasonable request.