Feasibility and Efficacy of Ultrasound-Guided Block of the Saphenous Nerve in the Adductor Canal

Manickam, Baskar P.; Perlas, Anahi; Duggan, Edel; Brull, Richard; Chan, Vincent; Ramlogan, Reva

doi:10.1097/aap.0b013e3181bfbf84

Cited by 167 publications

(128 citation statements)

References 9 publications

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“…9 Exact block location was performed by first placing the transducer mid-thigh, half the distance between the inguinal crease and the patella. The superficial femoral artery was identified dorsal to the sartorius muscle in shortaxis.…”

Section: Methodsmentioning

confidence: 99%

“…8 With ultrasound guidance, the feasibility of effective saphenous nerve block at the adductor canal has been shown. 9 The adductor canal block may provide superior analgesia over traditional distal saphenous nerve blocks for surgical procedures of the knee because this block includes the saphenous nerve, the nerve to the vastus medialis, and potentially the articular contribution of the obturator nerve to the knee joint. [10][11][12][13] Our primary hypothesis was that performing an adductor canal block as part of a multimodal analgesic regimen would result in improved analgesia immediately following arthroscopic medial meniscectomy.…”

Section: Résumémentioning

confidence: 99%

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Ultrasound-guided adductor canal block for arthroscopic medial meniscectomy: a randomized, double-blind trial

Hanson

Derby

Auyong

et al. 2013

Can J Anesth/J Can Anesth

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Purpose The saphenous nerve block using a landmarkbased approach has shown promise in reducing postoperative pain in patients undergoing arthroscopic medial meniscectomy. We hypothesized that performing an ultrasound-guided adductor canal saphenous block as part of a multimodal analgesic regimen would result in improved analgesia after arthroscopic medial meniscectomy. Methods Fifty patients presenting for ambulatory arthroscopic medial meniscectomy under general anesthesia were prospectively randomized to receive an ultrasoundguided adductor canal block with 0.5% ropivacaine or a sham subcutaneous injection of sterile saline. Our primary outcome was resting pain scores (numerical rating scale; NRS) upon arrival to the postanesthesia care unit (PACU). Secondary outcomes included NRS at six hours, 12 hr, 18 hr, and 24 hr; postoperative nausea; and postoperative opioid consumption.Results There was a statistically significant difference in mean NRS pain scores upon arrival to the PACU (P = 0.03): block group NRS = 1.71 (95% confidence interval [CI] 0.73 to 2.68) vs sham group NRS = 3.25 (95% CI 2.27 to 4.23). Cumulative opioid consumption (represented in oral morphine equivalents) over 24 hr was 71.8 mg (95% CI 56.5 to 87.2) in the sham group vs 44.9 mg (95% CI 29.5 to 60.2) in the block group (P = 0.016). Conclusions An ultrasound-guided block at the adductor canal as part of a combined multimodal analgesic regimen significantly reduces resting pain scores in the PACU following arthroscopic medial meniscectomy. Furthermore, 24-hr postoperative opioid consumption and pain scores were also reduced. RésuméObjectif Le bloc du nerf saphène à l'aide d'une approche par repères anatomiques s'est avéré prometteur pour réduire la douleur postopératoire chez les patients subissant une méniscectomie médiale par arthroscopie. Nous avons émis l'hypothèse qu'en réalisant un bloc échoguidé du canal adducteur du nerf saphène dans le cadre d'un régime analgésique multimodal, l'analgésie serait plus efficace après une méniscectomie médiale par arthroscopie. Méthode Cinquante patients devant subir une méniscectomie médiale par arthroscopie en ambulatoire sous anesthésie générale ont été randomisés de façon prospective à recevoir un bloc échoguidé du canal adducteur avec de la ropivacaïne 0,5 % ou une injection sous-cutanée fictive de solution saline stérile. Notre critère d'évaluation principal était les scores de douleur au repos (échelle d'évaluation numérique; É É N) à l'arrivée en salle de réveil. Les critères d'évaluation secondaires comprenaient l'É É N à six heures, 12 h, 18 h et 24 h; les nausées Author contributions Neil A. Hanson and Francis V. Salinas were involved in the study design.

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Section: Methodsmentioning

confidence: 99%

Section: Résumémentioning

confidence: 99%

Ultrasound-guided adductor canal block for arthroscopic medial meniscectomy: a randomized, double-blind trial

Hanson

Derby

Auyong

et al. 2013

Can J Anesth/J Can Anesth

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“…10 While our success rate is lower than Manickam et al's ultrasound-guided study evaluating the transsartorial perifemoral approach (100%, n = 20), their efficacy rate was determined by pinprick in the sensory distribution 30 min post-block. 7 On the other hand, our efficacy rate included evaluation in the postoperative period approximately 272 ± 117 min after nerve blocks were performed, and the threshold of block success in our study was based on highly stringent criteria with an endpoint of postoperative analgesia. We did not count a block successful unless the patient denied all pain in the PACU.…”

Section: Discussionmentioning

confidence: 99%

“…Previously described ultrasound-guided techniques have focused on blocking the saphenous nerve within the adductor canal or distal to it. [4][5][6][7] On the other hand, our technique initially involves identifying the femoral artery at the mid-thigh level as the surrogate landmark, and then identifying the nerve bundle in proximity to the femoral nerve. At this subsartorial location, the saphenous nerve may run with at least two additional nerves, the infrapatellar nerve 11 and the nerve to the vastus medialis.…”

Section: Discussionmentioning

confidence: 99%

“…6 Manickam et al conducted a small descriptive study to evaluate their ultrasound-guided technique at the distal adductor canal in the distal third of the thigh, and they found that the saphenous nerve was blocked successfully in all 20 of their patients, though success was determined solely by pinprick in the sensory distribution 30 min post-block. 7 Effective blockade of the saphenous nerve has been performed even more proximally as a non-ultrasound technique; this was described previously as the subsartorial approach. 8,9 However, there is a high degree of difficulty associated with reliably locating the surface landmarks relevant to this technique.…”

Section: Résumémentioning

confidence: 99%

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Efficacy of an ultrasound-guided subsartorial approach to saphenous nerve block: a case series

Tsai

Karnwal

Kakazu

et al. 2010

Can J Anesth/J Can Anesth

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Purpose The saphenous nerve, a branch of the femoral nerve, is a pure sensory nerve that supplies the anteromedial aspect of the lower leg from the knee to the foot. There is limited evidence of the effectiveness of ultrasoundguided techniques to block the saphenous nerve. We therefore undertook a retrospective case series to investigate the efficacy of an ultrasound-guided subsartorial approach to saphenous nerve block. Methods During a four-month period, all patients receiving a subsartorial saphenous nerve block for lower extremity surgery at our institution had their medical records reviewed. Patient demographics and data were recorded, including block characteristics, intraoperative anesthetic management, pre-block, post-block, and postoperative pain scores, as well as postoperative analgesic dosing. Preoperative block success was defined by minimal intraoperative analgesic administration and a pain score of 0 in the postanesthesia care unit not requiring analgesic supplementation. Postoperative block success was defined by reduction of pain score to 0 without need for additional analgesic dosing. Results Thirty-nine consecutive patients were identified as receiving an ultrasound-guided subsartorial saphenous nerve block. Overall, this ultrasound-guided technique was found to have a 77% success rate.Conclusion This case series shows that an ultrasoundguided subsartorial approach to saphenous nerve blockade is a moderately effective means to anesthetize the anteromedial lower extremity. The success rate is based on stringent criteria with an endpoint of postoperative analgesia. A randomized prospective study would provide a more definitive answer regarding the efficacy of this technique for surgical anesthesia. RésuméObjectif Le nerf saphe`ne interne, une branche du nerf fe´moral, est un nerf purement sensitif qui innerve la partie ante´rome´diale de la jambe, du genou jusqu'au pied. Il existe peu de preuves quant a`l'efficacite´des techniques guide´es par ultrason pour l'anesthe´sie du nerf saphe`ne interne. Nous avons donc entrepris une revue re´trospective d'une se´rie de cas afin d'examiner l'efficacite´d'une approche sous-sartoriale guide´e par ultrason pour l'anesthe´sie du nerf saphe`ne interne. Méthodes Pendant une pe´riode de quatre mois, les dossiers me´dicaux de tous les patients ayant be´ne´ficie´d'un bloc sous-sartorial du nerf saphe`ne interne pour une chirurgie du membre infe´rieur a`notre institution ont e´teŕ evus. Les donne´es de´mographiques et des renseignements sur ces patients ont e´te´recueillis, dont les caracte´ristiques du bloc, la prise en charge de l'anesthe´sie perope´ratoire, les scores de douleur pre´-anesthe´sie, postanesthe´sie et postope´ratoire, ainsi que la posologie analge´sique postope´ratoire. La re´ussite du bloc en pe´riode pre´ope´ratoire a e´te´de´finie par une administration perope´ratoire minime de substances analge´siques et un score de douleur a`0 ne nécessitant aucun apport analge´sique supple´mentaire a`la salle de re´veil. La re´ussite du bloc en pe´r...

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Reevaluation of the topographical anatomy of the mid‐thigh: A magnetic resonance and ultrasound imaging study

2022

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Adductor canal (AC) and sciatic nerve (SN) blockades are commonly used during total knee arthroplasties for postoperative pain control. Medical professionals have begun to utilize single injection combined regional anesthesia methods due to increased patient comfort. In this study, we examined the topographical anatomy of the midthigh, which is recommended as the appropriate intervention level for combined AC and SN blockades, in order to provide a safe approach for clinicians. We examined 184 thigh magnetic resonance images (MRI) from 98 patients. We measured the diameter of the mid-thigh, anterior thigh muscle thickness, subcutaneous adipose tissue thickness, and SN depth on the MRIs. We obtained ultrasound (US) images of the vastoadductor membranes (VAM) of 26 volunteers, and measured the vertical distances between the greater trochanter and the adductor tubercle (A) and the greater trochanter and the upper edge of the VAM (B). We then proportioned B to A in order to determine in which part of the thigh the AC was located. The AC was in the distal third of the thigh, and the SN's depth was located in the third quarter of the thigh's diameter. Only the adductor magnus, and no neurovascular structure, was at risk of injury between the AC and the SN. The upper edge of the VAM was 6.5 cm below the mid-thigh, therefore it is not appropriate to suggest performing an AC blockade at mid-thigh. We think that it is safe to perform a combined AC and SN blockade in a single injection in selected patients.

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Feasibility and Efficacy of Ultrasound-Guided Block of the Saphenous Nerve in the Adductor Canal

Abstract: In this small descriptive study, ultrasound-guided SN block in the adductor canal was technically simple and reliable, providing consistent nerve identification and block success.

Cited by 167 publications

References 9 publications

Ultrasound-guided adductor canal block for arthroscopic medial meniscectomy: a randomized, double-blind trial

Ultrasound-guided adductor canal block for arthroscopic medial meniscectomy: a randomized, double-blind trial

Efficacy of an ultrasound-guided subsartorial approach to saphenous nerve block: a case series

Reevaluation of the topographical anatomy of the mid‐thigh: A magnetic resonance and ultrasound imaging study

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