[This is a sample procedure note and may not match the corresponding guide exactly: As with all procedures there will be slight variations based on body habitus, technique preference, laterality, etc. Treat this as a starting point for a template. The brackets {{ }} are used in the body as placeholders for dynamic variables.]
[Written as if right sided. Full procedure technique and overview here.]
Surgeon:
Patient:
DOS:
Procedure: Diagnostic Genicular Nerve Block
Laterality: Right
Pre-op diagnosis:
M17.11 – Unilateral primary osteoarthritis, right knee
Post-op diagnosis: Same
Anesthesia: Local
Pre-Procedure Review: The initial consultation report has been reviewed and there are no changes with regard to the patient’s medical, social history and review of systems. The patient states that the symptoms are stable and unchanged since the last visit. My findings on physical examination today are grossly consistent with those documented on the previous follow-up note, at which time today’s procedure was scheduled. I will proceed today with the scheduled procedure and see the patient back for follow-up. The patient states understanding of the plan, and is in agreement.
Indication: To determine the extent to which the degenerative changes in the knee are mediated by the branches of the genicular nerve. If the block reproducibly results in significant relief of the patient’s usual pain for the appropriate duration of time (based on the local anesthetic used), then it could be concluded that the degeneration is the primary source of the patient’s pain. Positive diagnostic blocks are an indication for subsequent therapeutic treatment.
Description: The history and physical examination were reviewed to ensure accuracy, and the details of the procedure were reviewed with the patient who understands all of the risks and benefits involved. All questions were answered, and the patient is aware of all alternative therapeutic options. An informed consent was obtained, and the patient was directed to the procedure room. A “time-out” with two active identifiers of the patient, the procedure, and the site was performed. The patient was positioned supine on the fluoroscopy table. All pressure points were padded and checked routinely. The patient’s level of consciousness was monitored throughout. The knee was widely sterilized using a Betadine solution and was draped in a sterile manner.
In the lateral fluoroscopic view, the {{right}} SUPERIOR MEDIAL GENICULAR NERVE was located at the midpoint of the femur at the superior medial epicondyle. The skin overlying this was anesthetized with alkalinized 1% lidocaine. The 25 gauge 1.5 inch hypodermic needle was advanced slowly and carefully to the epicondyle. Placement was confirmed with multiple fluoroscopic views. Aspiration was negative for blood or other substances. Bupivacaine 0.25%, 1mL, was injected and the needle was withdrawn.
In the lateral fluoroscopic view, the {{right}} SUPERIOR LATERAL GENICULAR NERVE was located at the midpoint of the femur at the superior lateral epicondyle. The skin overlying this was anesthetized with alkalinized 1% lidocaine. The 25 gauge 1.5 inch hypodermic needle was advanced slowly and carefully to the epicondyle. Placement was confirmed with multiple fluoroscopic views. Aspiration was negative for blood or other substances. Bupivacaine 0.25%, 1mL, was injected and the needle was withdrawn.
In the lateral fluoroscopic view, the {{right}} INFERIOR MEDIAL GENICULAR NERVE was located at the midpoint of the tibia at the inferior medial epicondyle. The skin overlying this was anesthetized with alkalinized 1% lidocaine. The 25 gauge 1.5 inch hypodermic needle was advanced slowly and carefully to the epicondyle. Placement was confirmed with multiple fluoroscopic views. Aspiration was negative for blood or other substances. Bupivacaine 0.25%, 1mL, was injected and the needle was withdrawn.
Total fluoroscopy exposure was {{}} minutes ({{}}mGy).
The procedure was performed uneventfully and was well-tolerated by the patient. The patient was transferred to an observation room and recovered without incident. No adverse events were noted, and the patient was discharged home in stable condition. All potential side effects and adverse events have been discussed with the patient. The patient has been instructed to call my clinic at the first sign of an adverse event, or with any other concerning symptoms. A follow-up appointment has been made.
Anesthesia Addendum: {{standard anesthesia addendum if applicable}}