Genicular Nerve Block

by | Jun 5, 2026

Indications

  • Acute or chronic knee pain

Contraindications

  • Infection overlying injection site
  • Allergy to local anesthetic
  • Avoid the inferolateral injection site due to proximity to the common peroneal nerve and risk of foot drop

Equipment

  • 15cc of local anesthetic of choice
    • Approximately 5cc per nerve
  • 20-22G, 1.5-3.5in nerve block needle
  • Cleansing solution
  • Ultrasound with high-frequency linear transducer
  • Ultrasound transducer sterile cover

Preparation

Position

  • Position the patient supine
  • Slightly flex the knee by placing a pillow in the popliteal fossa

Ultrasound

Landmarks

Probe placement diagram for genicular nerve block targets around the distal femur and proximal tibia.

  • Place the probe with the marker oriented cephalad
  • Use a sagittal or slightly oblique plane
  • Scan along:
    • Medial distal femur
    • Lateral distal femur
    • Medial proximal tibia
  • At each site, identify the long-bone metaphysis at the point of initial bony upsloping
  • Look for adjacent genicular arteries when visible
  • Identify the three injection targets:
    • Superolateral genicular nerve distribution
    • Superomedial genicular nerve distribution
    • Inferomedial genicular nerve distribution
    • Avoid the inferolateral site to prevent common peroneal involvement

Technique

  1. Use in-plane needle visualization

Ultrasound probe positions and sonographic views for superior genicular nerve targets at the distal femur.

  1. For the superior nerves, advance the needle superior-to-inferior

Ultrasound probe position and sonographic view for the inferomedial genicular nerve target at the proximal tibia.

  1. For the inferior nerve, advance the needle inferior-to-superior
  2. Deposit approximately 5cc of local anesthetic against the periosteum at each site

Ultrasound needle trajectory for depositing local anesthetic along the periosteum at genicular nerve target sites.

  1. Visualize anesthetic lifting the overlying tendons and musculature
  2. Repeat for all three target sites for complete joint coverage

Examples

Source

  1. The POCUS Atlas