Rev. Soc. Esp. Dolor. 2021; 28(3): 154-168 / DOI: 10.20986/resed.2021.3900/2021
John Carlos Pérez, Diana Carolina Nájera, Manuel Herrero, Rafael Gálvez, Manuel Alejandro Sánchez, Alberto Vela, Ramón López
RESUMEN
Introducción: El uso de radiofrecuencia de los nervios geniculados para el tratamiento del dolor crónico de la rodilla secundario a osteoartrosis inició en 2011, y desde entonces se han realizado varios estudios con diferentes metodologías. Sin embargo, continúan generándose muchas dudas con respecto a las dianas anatómicas, los criterios de selección y la evidencia de su efectividad.
Materiales y métodos: Se realizó una búsqueda electrónica desde enero de 2011 hasta abril de 2020 en las siguientes bases de datos: PubMed®, Embase ®, Google Académico y Web of Science (WoS). La búsqueda inicial encontró 106 artículos, de los cuales tomamos 33 para realizar la presente revisión.
Resultados: Después de analizar cinco ensayos clínicos abiertos, un estudio de corte transversal, cuatro estudios prospectivos observacionales, ocho estudios de neuroanatomía, tres estudios retrospectivos, cuatro casos clínicos, dos series de casos, tres revisiones de la literatura y tres ensayos clínicos aleatorizados, controlados y doble ciegos; encontramos que la radiofrecuencia de los nervios geniculados disminuye el dolor asociado a la osteoartrosis de rodilla, consiguiendo una mejoría funcional con una duración variable del efecto analgésico entre tres y doce meses. A pesar del avance científico en esta área, aún no hay un consenso en cuanto a la neuroanatomía de la cápsula articular de la rodilla, la ubicación de las dianas, los parámetros empleados en radiofrecuencia y la utilidad de los bloqueos diagnósticos.
Conclusiones: Se necesitan más ensayos clínicos que estandaricen los parámetros utilizados y confirmen los resultados positivos de los estudios realizados con radiofrecuencia de los nervios geniculados. Aunque son pocos los casos de eventos adversos asociados a la radiofrecuencia de los nervios geniculados, necesitamos más estudios que avalen la seguridad de esta técnica y sus efectos secundarios a largo plazo en el tratamiento del dolor crónico de la rodilla secundario a osteoartrosis que no responde a otros tratamientos.
ABSTRACT
Introduction: The use of genicular nerve radiofrequency procedures to treat chronic knee pain due to osteoarthritis has surged in 2011, though many questions remain regarding anatomical targets, selection criteria, and evidence for effectiveness.
Materials and methods: An electronic search was performed from January 2011 to April 2020. Databases searched included PubMed®, Embase®, Google Scholar and Web of Science (WoS). The initial search found 106 articles. Thirty-three articles were taken for this review.
Results: After analyzing five open clinical trials, one cross-sectional study, four prospective observational studies, eight neuroanatomy studies, three retrospective studies, four clinical cases, two case series, three literature reviews and three randomized, double blind, controlled trials; we found genicular nerve radiofrequency achieves a pain reduction and functional improvement with a variable duration, between three and twelve months. There is no consensus regarding the neuroanatomy of the knee joint capsule, the location of the targets, the radiofrequency parameters used and the usefulness of diagnostic blocks.
Conclusion: More clinical trials are needed to standardize the parameters used and confirm the positive results of genicular nerve radiofrequency. Although lonthere are few cases of adverse events associated with radiofrequency of the geniculate nerves, more studies are needed to support the safety of this technique and its long-term side effects in osteoarthritis knee pain management associated that do not respond to other previous medical treatments.
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