Re-defining the anatomical structures for blocking the nerves in adductor canal and sciatic nerve through the same injection site: an anatomical study

Kendir, Simel; Torun, Bilge İpek; Akkaya, Taylan; Cömert, Ayhan; Tüccar, Eray; Tekdemi̇r, İbrahi̇m

doi:10.1007/s00276-018-2094-1

Cited by 10 publications

(20 citation statements)

References 33 publications

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“…The patient was placed in the supine position; further, the hip on the operated side was slightly flexed and externally rotated. After skin sterilization, the transducer was placed perpendicularly to the skin on the medial mid-thigh using a sterile ultrasound gel and transducer cover (8). Upon identification of the femur, the transducer was slightly adjusted to allow clear SN visualization, which was located at the medial side of the femur beneath the adductor magnus muscle (Figure 2A).…”

Section: Ultrasound-guided Anterior Approachmentioning

confidence: 99%

Efficacy and safety of ultrasound-guided above-knee lateral approach for popliteal sciatic nerve block in surgeries below the knee: a randomized controlled trial

Zhu¹,

Chanjuan²,

Zhang³

et al. 2021

Ann Palliat Med

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Background: Ultrasound guidance has become a standard method for detection of nerve structures in regional anesthesia. During ultrasound-guided blockade, to identify anatomical structures is crucial but can be challenging. In clinical practice, we find a wide difference in the visibility score of the sciatic nerve (SN) through different approaches. This study aimed to compare SNB through the anterior and above-knee lateral approach in terms of identification ease, performance efficacy, and safety.Methods: Patients scheduled for below-knee surgery were randomized to either receive SNB using the above-knee lateral approach (Group L, n=27) or the anterior approach (Group A, n=26). The primary outcome was the visibility score of SN. Secondary outcomes included the time taken to identify the SN, nerve depth, success rate of SN identification, number of needle passes, time to elicit foot flexion, needle depth, and occurrence of SNB complications. Additionally, the sensory block onset and analgesia duration were assessed.Results: We included 53 adult patients. Compared with Group A, Group L showed a higher SN visibility score [3.25 (3.17, 3.67) vs. 2.50 (1.86, 2.68), P<0.001]. The scan time was significantly shorter in Group L 8.70 (6.01) s vs. 31.54 (11.87) s, P<0.001). The depth of the SN was 3.20 (0.56) cm in Group L and 5.53 (0.84) cm in Group A (P<0.001), and the needle insertion depth was 7.15 (0.90) cm in group L and 8.32 (1.13) cm in Group A (P<0.001). The number of needle passes was less in Group L, as well as the time to elicit foot flexion, and the time taken to perform the SN block (all P<0.001). The success rate of SN identification was non-significantly higher in Group L. There was no significant between-group difference in the onset of sensory block, as well as postoperative analgesia duration. None of the approaches involved acute systemic toxicity and hematoma occurrence.Conclusions: Based on the visibility score, the above-knee lateral approach allowed easy SN identification and safe SNB. Using the ultrasound-guided above-knee lateral approach for SNB in below-knee surgeries could be a reliable choice.

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Section: Ultrasound-guided Anterior Approachmentioning

confidence: 99%

Efficacy and safety of ultrasound-guided above-knee lateral approach for popliteal sciatic nerve block in surgeries below the knee: a randomized controlled trial

Zhu¹,

Chanjuan²,

Zhang³

et al. 2021

Ann Palliat Med

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“…This fascial compartment is on the surface of the VM. 3,12–15 This separation of the NVM and its terminal branches from the SN and FA is maintained further distally into the adductor canal. 1…”

Section: Key Anatomical Relationships In the Thighmentioning

confidence: 96%

“…This fascial compartment is on the surface of the VM. 3,[12][13][14][15] This separation of the NVM and its terminal branches from the SN and FA is maintained further distally into the adductor canal. 1 Distal Femoral Triangle Lateral to the distal femoral triangle, the SAM is anterior to the FA.…”

Section: Anesthesia and Analgesiamentioning

confidence: 99%

“…2 Some authors have reported that the posterior branch continues with the FA into the adductor canal but do not clearly indicate in which fascial compartment it lies. 12,14 It is more likely that the nerve travels in the subsartorial compartment, which is separated by fascia from the femoral vessels and SN (see below). 1,13 A key anatomical feature of the distal femoral triangle and adductor canal is the presence of fascia that extends from the fascia of the vastus medialis to the fascia of the adductor muscles, effectively forming a distinct triangular subsartorial canal that contains the FA and some of the nerves.…”

Section: Anesthesia and Analgesiamentioning

confidence: 99%

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Pro and Con: How Important Is the Exact Location of Adductor Canal and Femoral Triangle Blocks?

Woodworth

Arner

Nelsen

et al. 2023

Anesthesia &Amp; Analgesia

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In this Pro-Con commentary article, we debate the importance of anterior thigh block locations for analgesia following total knee arthroplasty. The debate is based on the current literature, our understanding of the relevant anatomy, and a clinical perspective. We review the anatomy of the different fascial compartments, the course of different nerves with respect to the fascia, and the anatomy of the nerve supply to the knee joint. The Pro side of the debate supports the view that more distal block locations in the anterior thigh increase the risk of excluding the medial and intermediate cutaneous nerves of the thigh and the nerve to the vastus medialis, while increasing the risk of spread to the popliteal fossa, making distal femoral triangle block the preferred location. The Con side of the debate adopts the view that while the exact location of local anesthetic injection appears anatomically important, it has not been proven to be clinically relevant.

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“…Further, the sartorius muscle covers the adductor canal (subsartorial canal), a musculoaponeurotic tunnel on the medial aspect of the distal two-thirds of the thigh. The femoral artery and vein, saphenous nerve, posterior branch of the obturator nerve, and, in some cases, medial retinacular nerve or medial femoral cutaneous nerve are contained in the adductor canal [ 3 , 4 , 5 ]. The sartorius muscle is innervated by the femoral nerve and contributes to hip external rotation and flexion, knee internal rotation and flexion, as well as being a secondary valgus stabilizer of the knee [ 1 , 2 ].…”

Section: Introductionmentioning

confidence: 99%

Regression Model Decreasing the Risk of Femoral Neurovascular Bundle Accidental Puncture

et al. 2022

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Although most of the adverse events derived from dry needling are minor, avoiding potential hazards for patients including accidental invasion of vessels, ganglia, and nerves is essential to ensure patients’ safety. We aimed to investigate the contribution of predictors explaining the variance of sartorius muscle depth limit at proximal third and middle thigh as these locations lead to an augmented risk of neurovascular bundle invasion during dry needling application. A diagnostic study was conducted on 84 subjects to calculate the accuracy of a prediction model for sartorius depth, as assessed with ultrasound imaging, based on sex, age, height, weight, body mass index (BMI), thigh perimeter, and length. After calculating a correlation matrix, a multiple linear regression analysis was performed to detect those variables contributing to the sartorius deep limit in both locations. Although males showed greater thigh perimeter than women (p < 0.001), the deep limit of the sartorius muscle was significantly more superficial for both the proximal third (p = 0.003) and the mid-third (p = 0.004) points. No side-to-side anthropometric differences were found (p > 0.05). In addition, we found sartorius muscle depth to be associated with the proximal and mid-third girth, gender, height, and BMI (all, p < 0.01). Gender, proximal-third girth, and BMI explained 51.1% and 42.6% of the variance for the sartorius deep limit at the proximal and the mid-third, respectively. This study analyzed whether anthropometric features could predict sartorius muscle depth in healthy participants for assisting clinicians in choosing the optimal needle length to avoid accidental femoral bundle puncture.

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Re-defining the anatomical structures for blocking the nerves in adductor canal and sciatic nerve through the same injection site: an anatomical study

Abstract: Blocking the sciatic nerve and the nerves within the adductor canal which innervate the knee joint through the same injection site seems anatomically possible without injuring any neurovascular structures.

Cited by 10 publications

References 33 publications

Efficacy and safety of ultrasound-guided above-knee lateral approach for popliteal sciatic nerve block in surgeries below the knee: a randomized controlled trial

Efficacy and safety of ultrasound-guided above-knee lateral approach for popliteal sciatic nerve block in surgeries below the knee: a randomized controlled trial

Pro and Con: How Important Is the Exact Location of Adductor Canal and Femoral Triangle Blocks?

Regression Model Decreasing the Risk of Femoral Neurovascular Bundle Accidental Puncture

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