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Background and Aims This study is designed to test the efficacy of adding Depomedrol a long-acting steroid to lidocaine for relieving chronic osteoarthritic knee pain and reducing opioid requirements. For this purpose, Depomedrol is added to lidocaine for ultrasound-guided Genicular nerve block. A genicular nerve block is a minimally invasive procedure used for diagnosing and treating knee pain, particularly in patients with osteoarthritis or those who have undergone knee surgery but still experience discomfort. It targets the genicular nerves, which are responsible for transmitting pain signals from the knee to the brain. The procedure involves the precise injection of a local anesthetic (and sometimes a steroid for longer-lasting relief) around the genicular nerves. This effectively interrupts the pain signals, providing temporary relief from knee pain.Methods 60 patients were enrolled prospectively in this study , aging from 40–85 year old, ASA II-III. 30 patients as controlled group with lidocaine 2% (6 ml) US guided genicular nerve block,30 patients were in Depomedrol Group with 80 mg depomedrol mixed with lidocaine 2% (6 ml). All nerve blocks were performed in out patient clinic as pain clinic. follow up with patients last over 3 months duration following injection.Results In the Depo Group, patients showed more satisfaction than lidocaine group regarding their pain relief score , ability to walk long distances, decreasing analgesic medications consumption.Conclusions Adding Depomedrol to local anesthesia medication as adjuvant can provide extended pain relief for chronic osteoarthritic knee pain lasting weeks to few months.