Systematic sonographic and evoked motor identification of the nerve to vastus medialis during adductor canal block

Dooley, Joshua; Bullock, W. Michael; Kumar, Amanda H.; MacLeod, David B.; Gadsden, Jeff

doi:10.1136/rapm-2019-101232

Cited by 6 publications

(5 citation statements)

References 6 publications

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“…This is due to the sensory fibers to the knee contained within the NVM and its terminal branch, the medial retinacular nerve. 1,12,15,[21][22][23][24] Other important nerves in this region include the posterior branch of the MFCN and the obturator nerve. Some studies on adductor canal block describe the MFCN (most likely the posterior branch) to be within the adductor canal without specifying whether it was superficial or deep to the VAM.…”

Section: Adductor Canalmentioning

confidence: 99%

“…25 Some advocate a separate local anesthetic injection within the fascial covering of the NVM be performed along with distal femoral triangle or adductor canal blocks to avoid relying on diffusion through the fascia to block this nerve. 24 It is possible the NVM may be excluded with adductor canal blocks compared to blocks in the distal femoral triangle, but this remains unproven.…”

Section: Pro-the Location For Injection Mattersmentioning

confidence: 99%

“…This is due to the sensory fibers to the knee contained within the NVM and its terminal branch, the medial retinacular nerve. 1,12,15,21-24…”

Section: Key Anatomical Relationships In the Thighmentioning

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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Section: Adductor Canalmentioning

confidence: 99%

Section: Pro-the Location For Injection Mattersmentioning

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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“…This nerve can be challenging to identify on ultrasound, resulting in it going unblocked or injured during needle advancement towards the femoral artery. Dual guidance in this instance has been shown to reliably identify the nerve to vastus medialis, even when not viewed on ultrasound, resulting in a block that is both effective (local anaesthetic is deliberately administered at this location) and safe (avoidance of needle‐nerve contact) [44]. Similarly, there has been concern raised over the potential for accidental injury to the suprascapular nerve during the retroclavicular block, as the acoustic shadow of the clavicle hides that portion of the needle trajectory and the nerve is not visible [45].…”

Section: Nerve Stimulation As a Monitor For Nerve Block Safetymentioning

confidence: 99%

The role of peripheral nerve stimulation in the era of ultrasound‐guided regional anaesthesia

Gadsden

2021

Anaesthesia

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Summary With the widespread use of ultrasound for localising nerves during peripheral nerve blockade, the value of electrical nerve stimulation of evoked motor responses has been questioned. Studies continue to show that, compared with nerve stimulation, ultrasound guidance alone leads to: significantly improved block success; decreased need for rescue analgesia; decreased procedural pain; and lower rates of vascular puncture. Nerve stimulation combined with ultrasound does also not appear to improve block success rates, apart from those blocks where the nerves are challenging to view, such as the obturator nerve. The role of nerve stimulation has changed in the last 15 years from a technique to locate nerves to that of an adjunct to ultrasound. Nerve stimulation can serve as a monitor against needle‐nerve contact and may be useful in avoiding nerves that are in the needle trajectory during specific ultrasound guided techniques. Nerve stimulation is also a useful adjunct in teaching novices ultrasound‐guided regional anaesthesia, especially when the position and or appearance of nerves may be variable. In this review, the changing role of nerve stimulation in contemporary regional anaesthetic practice is presented and discussed.

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“…27 Additionally, for blocks with difficulty in nerve visualization such as the adductor canal and posterior clavicular blocks, double-monitoring using combined US and NS guidance was effective in preventing neuropathies. 28,29 Since neuropathies are rare, chance variation was possibly detected. Therefore, there may be little differences in the incidence of neuropathies between US with NS and NS guidance alone.…”

mentioning

confidence: 99%

Neuropathies Following an Ultrasound-Guided Axillary Brachial Plexus Block

Koh,

Tatsuki,

Sakuraba

et al. 2023

LRA

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Ultrasound-guided brachial plexus block (UGBPB) has interscalene, supraclavicular, infraclavicular, and axillary approaches. The axillary block is considered to be the safest and with fewer adverse events compared to the interscalene (eg, phrenic nerve block, spinal cord or vertebral artery puncture) and supraclavicular (eg, pneumothorax). However, with regard to postoperative neurological symptoms (PONS), it is controversial whether its incidence after an axillary block was higher than that after non-axillary approaches". In this study, we investigated whether the incidence of a neuropathy after an axillary block was higher than that after nonaxillary approaches. Patients and Methods: This was a single-center, retrospective cohort study. All UGBPBs were performed under general anesthesia between January 2014 and March 2020. The outcomes included the overall incidence of PONS and neuropathies for axillary and nonaxillary approaches. The etiology, symptoms, and outcomes of patients were investigated. Results: Of the 992 patients, 143 (14%) and 849 (86%) were subjected to axillary and non-axillary approaches, respectively. Among 19 cases (19.2:1000; 95% confidence interval [CI], 18.2-20.1) of PONS, four (4.0:1000; 95% CI, 3.8-4.2) were neuropathies attributed to the UGBPB, three (21.0:1000; 95% CI, to the axillary and one (2.8:1000; 95% CI, 2.6-3.1) to non-axillary approaches. The incidence of neuropathies after an axillary block was significantly higher than that after non-axillary approaches (P = 0.005). Conclusion:The incidence of neuropathies after US-guided axillary block under general anesthesia was significantly higher than that after non-axillary approaches.

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Systematic sonographic and evoked motor identification of the nerve to vastus medialis during adductor canal block

Cited by 6 publications

References 6 publications

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

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

The role of peripheral nerve stimulation in the era of ultrasound‐guided regional anaesthesia

Neuropathies Following an Ultrasound-Guided Axillary Brachial Plexus Block

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