A genicular nerve block is a minimally invasive procedure that places numbing medication onto the genicular nerves — the small sensory nerves that carry pain signals from the knee. By interrupting these nerves, the block both confirms they are the source of your pain and provides short-term relief. Dr. Imran Qureshi uses it for chronic knee arthritis pain and persistent pain after knee replacement, especially when injections have stopped working. A successful block predicts whether you will benefit from genicular radiofrequency ablation (RFA), a follow-up procedure that can provide 6 to 12 months or more of relief. The block is performed under image guidance at the Katy, TX office and is covered by most insurance plans.
What is a genicular nerve block?
The knee is supplied by a network of small sensory nerves called the genicular nerves — primarily the superior medial, superior lateral, and inferior medial genicular nerves. These nerves don't control any muscles; their only job is carrying pain signals from the knee to the brain. A genicular nerve block places a small amount of local anesthetic onto these nerves to temporarily switch off those pain signals.
The block serves two purposes at once. First, it is diagnostic: if numbing the genicular nerves substantially relieves your knee pain, that confirms these nerves are carrying the pain and that you are likely to respond to a longer-lasting procedure. Second, it is therapeutic: it provides a window of relief on its own. Because the genicular nerves are sensory only, blocking them does not weaken the leg or affect how you walk.
What conditions does a genicular nerve block treat?
Dr. Qureshi commonly uses genicular nerve blocks for:
- Chronic knee osteoarthritis pain — especially moderate-to-severe arthritis that no longer responds to joint injections or gel injections
- Persistent pain after knee replacement — when a well-placed implant still hurts, the genicular nerves are often the culprit
- Knee pain in patients who can't have surgery — those who are not surgical candidates due to age, health, or preference
- Patients wanting to delay knee replacement — a way to manage pain and stay active longer
- Knee arthritis pain that limits walking, stairs, or sleep despite conservative care
See our full knee pain and arthritis overview for all of the options Dr. Qureshi offers for the knee.
The genicular nerve block and radiofrequency ablation pathway
Genicular nerve blocks are usually the first step in a two-step pathway:
- Step 1 — the diagnostic block: Local anesthetic is placed on the genicular nerves. You track your pain over the next 24 hours. If you get significant relief (commonly defined as a 50% or greater reduction in pain), the test is positive.
- Step 2 — radiofrequency ablation (RFA): If the block worked, Dr. Qureshi can use controlled heat to interrupt the same nerves for a much longer period — typically 6 to 12 months or more. Because RFA carries through on the relief the block predicted, the block is how we make sure RFA is worth doing for you.
Some patients use the block on its own for periodic relief; others use it as the gateway to longer-lasting ablation. Dr. Qureshi will explain which pathway fits your knee.
What happens during a genicular nerve block?
The procedure is quick, done in the office, and well-tolerated:
- Positioning: You lie on your back with the knee slightly supported.
- Skin prep and numbing: The skin over the knee is cleaned and numbed with local anesthetic.
- Image guidance: Dr. Qureshi uses fluoroscopy (live X-ray) or ultrasound to guide thin needles to the precise location of each genicular nerve at the edges of the knee.
- Anesthetic delivery: A small amount of local anesthetic is placed on each nerve. The whole procedure usually takes 15 to 20 minutes.
- Walk out and track: You go home the same day and keep a simple pain diary for 24 hours to record how much relief you get — this result guides the next step.
Recovery and timeline
- First few hours: The anesthetic takes effect quickly. Many patients notice their knee pain drop substantially — this is the result we are looking for.
- First 24 hours: Keep your pain diary. Avoid strenuous activity, but normal walking is fine. Mild soreness at the needle sites is normal.
- 1 to 3 days: As the anesthetic wears off, the diagnostic relief fades. How much relief you got — and for how long — tells Dr. Qureshi whether RFA is likely to help.
- Next step: If the block was successful, Dr. Qureshi will discuss scheduling radiofrequency ablation for longer-lasting relief.
Am I a candidate for a genicular nerve block?
You may be a good candidate if you have:
- Chronic knee pain from osteoarthritis, especially moderate-to-severe
- Pain that no longer responds well to gel injections, cortisone, or physical therapy
- Persistent pain after a knee replacement
- A wish to avoid, delay, or are not a candidate for knee replacement surgery
The procedure is avoided in the setting of active infection at the injection site, certain bleeding disorders, or uncontrolled anticoagulation that cannot be safely adjusted. Dr. Qureshi will review your history and medications before scheduling.
What are the risks and side effects of a genicular nerve block?
Genicular nerve blocks are very safe and minimally invasive. Possible side effects:
- Temporary soreness at the needle sites for a day or two
- Temporary numbness or a slightly different sensation around the knee while the anesthetic is active
- Minor bruising at the injection sites
- Allergic reaction to the anesthetic: Very rare
- Infection or bleeding: Very rare with proper sterile technique and image guidance
Because the genicular nerves are purely sensory, the block does not cause leg weakness or affect your ability to walk.
Genicular nerve block vs. knee replacement: which makes sense first?
For chronic knee arthritis pain that hasn't responded to injections, a genicular nerve block — and the radiofrequency ablation it can lead to — is a minimally invasive way to manage pain without the recovery, risks, and downtime of major surgery. It is especially valuable for patients who want to delay knee replacement, are not surgical candidates, or still have pain after a replacement. Knee replacement remains the definitive treatment for end-stage arthritis, but the genicular pathway can provide meaningful relief and keep you active in the meantime. Dr. Qureshi will give you an honest assessment of where these options fit for your knee.
Why choose Dr. Qureshi for a genicular nerve block in Katy, TX?
Dr. Imran Qureshi is a board-certified interventional pain management and sports medicine physician with extensive experience in image-guided knee procedures, including genicular nerve blocks and radiofrequency ablation. He performs every block under fluoroscopic or ultrasound guidance for precise targeting of each nerve, and uses the diagnostic result to make sure any follow-up ablation is genuinely worth doing. The Katy office offers same-week appointments, accepts most major insurance plans, and serves patients from Cinco Ranch, Cypress, Fulshear, Richmond, and Sugar Land.