Sample Opnote – Knee Genicular Nerve Radiofrequency Ablation

[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: Genicular Nerve Radiofrequency Ablation

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 ablate the nerves involved in the transmission of pain arising from degenerative joint disease in the knee. The patient has undergone diagnostic nerve block of the branches of the genicular nerve, which produced satisfactory improvement of the usual pain for the expected duration of time. Based on this, the patient is an ideal candidate for radiofrequency ablation of the same branches, which should provide significant long-term relief.

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 anteroposterior 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 radiofrequency needle with a 10mm curved active tip was advanced in a target fashion slowly and carefully to the epicondyle. Placement was confirmed with multiple fluoroscopic views. Aspiration was negative for blood or other substances. Local anesthesia was accomplished with 2mL of 1% alkalinized lidocaine. The stylet was removed, and the radiofrequency probe was inserted through the cannula. Non-pulsed radiofrequency ablation was performed at a temperature of 80 degrees centigrade for sixty seconds. The needle was then withdrawn.

In the anteroposterior 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 radiofrequency needle with a 10mm curved active tip was advanced in a target fashion slowly and carefully to the epicondyle. Placement was confirmed with multiple fluoroscopic views. Aspiration was negative for blood or other substances. Local anesthesia was accomplished with 2mL of 1% alkalinized lidocaine. The stylet was removed, and the radiofrequency probe was inserted through the cannula. Non-pulsed radiofrequency ablation was performed at a temperature of 80 degrees centigrade for sixty seconds. The needle was then withdrawn.

In the anteroposterior fluoroscopic view, the {{right}} INFERIOR MEDIAL GENICULAR NERVE was located at the midpoint of the tibia at the superior medial epicondyle. The skin overlying this was anesthetized with alkalinized 1% lidocaine. The radiofrequency needle with a 10mm curved active tip was advanced in a target fashion slowly and carefully to the epicondyle. Placement was confirmed with multiple fluoroscopic views. Aspiration was negative for blood or other substances. Local anesthesia was accomplished with 2mL of 1% alkalinized lidocaine. The stylet was removed, and the radiofrequency probe was inserted through the cannula. Non-pulsed radiofrequency ablation was performed at a temperature of 80 degrees centigrade for sixty seconds. The needle was then 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}}