Genivs Plane Block-A Novel Mix of Regional Blocks for Knee Surgery: Used to Provide Complete Analgesia for Through Knee Amputation With a Continuous Distal Femoral Periosteal Catheter in a Pediatric Patient: A Case Report.

Through‑knee amputation is associated with severe postoperative pain and a high risk of phantom limb pain, particularly in patients with poorly controlled acute post-amputation pain. We describe the use of a novel regional plane block that targets a mix of nerve blocks - genicular+iPACK+vastus nerves, which we abbreviated Genivs. We targeted this location and performed a continuous distal femoral periosteal catheter technique in a pediatric patient following traumatic through‑knee amputation. We tried this novel approach after the patient's pain did not improve with targeted muscle re-innervation (TMR), epidural analgesia, systemic opioids, ketamine infusion, and conventional peripheral nerve blocks. Catheter placement adjacent to the anterior periosteum of the distal femur resulted in rapid opioid-sparing, improved participation in rehabilitation, and sustained reduction in phantom limb pain. Plausible anatomic mechanisms are discussed.