Sathish, K (2020) Comparative Efficacy in the Outcome of Genicular Nerve Block and Intra Articular Injection of Platelet Rich Plasma Versus Intra Articular Injection of Platelet Rich Plasma in the Treatment of Patients with Grade I and II Osteo Arthritis of Knee: A Randomized Control Trial. Masters thesis, Madras Medical College, Chennai.
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Abstract
INTRODUCTION: Osteoarthritis (OA) particularly knee OA, is one of the most common delimiting disease affecting people in the world. Currently other than the pharmacologic and surgical modalities usage of Platelet Rich Plasma (PRP) is emerging as a novel technique in the treatment of OA. OBJECTIVES: The study was aimed to assess the efficacy of Genicular nerve block using local anaesthetic and PRP versus only PRP among patients suffering from grade I and II knee OA. METHODOLOGY: The study was an open double-blind randomised control trial among 100 subjects with grade I and II knee OA. They were divided based on computer generated random numbers into two groups. Group A: Genicular nerve (Superior medial genicular nerve, Superior lateral genicular nerve and Inferior medial genicular nerve) was blocked with 6ml of 0.5% Bupivacaine which is distributed equally to the targeted three injection sites under ultrasound guidance. Genicular nerve block (GNB) is followed by Intra articular injection of 2-4ml of autologous platelet rich plasma by inferolateral approach. This procedure was repeated at regular 4 weeks interval for three cycles. For Group B: 2-4ml of Intra articular autologous platelet rich plasma by inferolateral approach. This procedure was repeated at regular 4 weeks interval for three cycles. Pain relief and functional outcome was analysed with VAS score, Numerical rating scale and Western Ontario and McMaster universities (WOMAC) Osteoarthritis Index before the intervention and on first post intervention day and at 2 weeks, 4 weeks, 8 weeks, 12 weeks, 16 weeks and 24 weeks. RESULTS: The study was done among 100 subjects. The mean (SD) age of the GNB+PRP group and PRP group was 57.10 (9.53) years and 57.90(8.89) years respectively. The minimum age of the population was 40 years and maximum age was 82 years. The mean (SD) age of the population was 57.34 (9.28) years. Both the group had most subjects in 50-59 years. [18 (36%) in GNB+PRP vs 21 (42%) in PRP group]. In the study majority 68(68%) of the study subjects were females and 32 (32%) of the subjects were males. Most 45 (45%) of the population had their left knee affected. Next commonly affected was right knee 35 (35%). 38(38%) of the subjects had an X ray grade I and 62 (62%) of the subjects had an X ray grade II. The mean (SD) of the VAS score at baseline, 1st day, after 2 weeks, after 4 weeks, after 8 weeks, after 12 weeks, after 16 weeks and after 24 weeks were 8.31(0.72), 2.27(1.57), 1.79(1.25), 1.48(1.16), 1.06(0.84), 0.87(0.77), 0.83(0.75) and 0.83(0.75) respectively. The mean (SD) of the NPRS score at baseline, 1st day, after 2 weeks, after 4 weeks, after 8 weeks, after 12 weeks, after 16 weeks and after 24 weeks were 8.32(0.72), 7.34(0.76), 5.39(0.99), 3.84(0.79), 3.11(0.92), 2.61(0.72), 2.23(0.66) and 1.81(0.68) respectively. The mean (SD) of the WOMAC score at baseline, 1st day, after 2 weeks, after 4 weeks, after 8 weeks, after 12 weeks, after 16 weeks and after 24 weeks were 68.97(13.25), 25.25(15.75), 21.21(14.19), 17.86(13.02), 12.67(10.41), 10.15(9.74), 9.87(9.41) and 9.87(9.41) respectively. There is significant difference between the two groups across the time periods in terms of VAS score. Group A (GNB+PRP) showed better outcome in terms of decreased VAS score. There was significant difference between the two groups across the time periods in terms of WOMAC score. Group A (GNB+PRP) showed better outcome in terms of decreased WOMAC score. There was an association between NPRS score across different time periods between the groups. There is a significant difference between the two groups after 2 weeks, after 8 weeks and 16 weeks. CONCLUSION: The study showed a better outcome among subjects receiving the GNB and PRP together across the time periods; also, significant reduction occurred in the group with PRP also less in comparison with the other group. The usage of PRP with adjuvants can be an emerging novel treatment in case of knee OA.
| Item Type: | Thesis (Masters) |
|---|---|
| Additional Information: | 201729002 |
| Uncontrolled Keywords: | Osteoarthritis, Platelet Rich Plasma, Genicular Nerve Block. |
| Subjects: | MEDICAL > Physical Medicine and Rehabilitation |
| Depositing User: | Subramani R |
| Date Deposited: | 04 Feb 2021 18:01 |
| Last Modified: | 04 Feb 2021 18:01 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/13850 |
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