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Background and Aims Knee osteoarthritis (gonarthrosis) is a prevalent cause of chronic pain and functional impairment in elderly patients. Conventional pharmacological treatments, including nonsteroidal anti-inflammatory drugs (NSAIDs), paracetamol, and co-analgesics, often fail to provide sufficient pain relief. Ultrasound-guided chemical ablation of genicular nerves using 95% ethanol has emerged as a potential non-surgical intervention for pain management in knee osteoarthritis. This study aimed to assess the efficacy and safety of ultrasound-guided chemical ablation of genicular nerves with 95% ethanol in elderly patients with severe knee osteoarthritis.Methods This double-blind, single-center, randomized controlled trial ( NCT06087601) was registered at ClinicalTrials.gov on October 10, 2023, with ethics approval from the Bioethics Committee of Poznan University of Medical Sciences (223/23, March 9, 2023). Conducted at the Pain Treatment Clinic, Transfiguration of Jesus Clinical Hospital, the trial enrolled 100 patients (aged 65–92) with Kellgren-Lawrence grade 3 or 4 knee osteoarthritis and inadequate pain control (NRS >3). Patients were randomized to ultrasound-guided genicular nerve neurolysis with 95% ethanol (n=50) or a sham procedure (n=50). Neurolysis used 4 × 0.5 ml of 95% ethanol. The primary outcome was pain intensity (NRS) at 7, 30 days, and 3, 6 months. Secondary outcomes included quality of life (EQ-5D-5L), opioid consumption, and neurological complications.Results Pain scores (NRS) and total opioid consumption were significantly lower in the neurolysis group compared to the sham group at all time points (p<0.0001). Quality of life scores (EQ-5D-5L) improved significantly in the neurolysis group, with a lower total opioid consumption (p<0.0001). No neurological deficits were observed in either group throughout the study duration.Conclusions Ultrasound-guided chemical ablation of genicular nerves with 95% ethanol is a safe and effective treatment for severe knee osteoarthritis pain. It significantly reduces pain scores and opioid consumption while improving patients‘ quality of life, without inducing neurological deficits.Abstract OP11 Table 1Primary outcomesAbstract OP11 Table 2Secondary outcomesAbstract OP11 Table 3Health questionnaire – EQ-5D-5L