Block of the Month – September 2019 – Adductor Canal Block

Adductor Canal Block A reasonable alternative option for postoperative pain relief other than a femoral nerve block. This technique can be used for: o Lower leg, foot and ankle surgery in combination with a popliteal-sciatic nerve block o Knee procedures…

Block of the Month - September 2019 - Adductor Canal Block

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Adductor Canal Block
A reasonable alternative option for postoperative pain relief other than a femoral nerve block. This technique can be used for:
o Lower leg, foot and ankle surgery in combination with a popliteal-sciatic nerve block
o Knee procedures (Arthroscopy, Patellar surgery, ACL, MCL Reconstruction)
• Benefits of adductor canal block1
o Targeted sensory blockade
o Limited quadriceps weakness to facilitate ambulation and postoperative rehabilitation
o Easier assessment of possible compartment syndrome
Unique Contraindications:
o None other than contraindications possible with other peripheral nerve blocks
• Unique Complications:
o Neuropathy
 Occurs in 6% of patients2
 Symptoms include electric shock sensation at the area innervated and paresthesia. Most patient recover within 3 weeks.2
o Vascular puncture
 Only 1 reported case of iatrogenic pseudoaneurysm during an ultrasound-guided catheter placement3
o Systemic toxicity of local anesthetics4
 Incidence of LAST in 12,000 ultrasound-guided blocks was 0.08 per 1,000 blocks5
• Technique:
o Position probe at transverse position to the longitudinal axis of the thigh approximately halfway between the anterior superior iliac spine and the patella (mid-thigh level).
o Identify the visible pulsation of the femoral artery, vein just inferior to it and the saphenous nerve just lateral to the artery.6
 Before needle insertion, do a thorough ultrasound examination of the femoral artery and its distributions to detect possible anatomic variations for prevention of vascular puncture.3
o Identify the borders of the adductor canal: sartorius muscle anteriorly, vastus medialis posterolaterally and adductor longus posteromedially
o At our institution, we normally use 5-15 ml of Ropivacaine 0.5%, depending on whether the block used was in combination with a popliteal-sciatic block for foot and ankle surgery or as a sole block for knee surgery.

References:
1. Ardon A, Greengrass R, Clendenen S. 2014. Diagnosis of post-operative compressive neuropathy aided by continuous adductor block. Pain Med. 15(8):1432-3.
2. Seo J, et al. 2017. Does combination therapy of popliteal sciatic nerve block and adductor canal block effectively control early postoperative pain after total knee arthroplasty? Knee Surg Relat Res. 29(4):276-281.
3. Cappelleri G, et al. 2016. Iatrogenic pseudoaneurysm after continuous adductor canal block. A A Case Rep. 7(9):200-202.
4. Rasouli M & Viscusi E. 2017. “Adductor canal block for knee surgeries: an emerging analgesic technique.” Arch Bone Jt Surg, 5(3):131-132.
5. Howell R, et al. 2016. Peripheral nerve block for surgery about the knee. JBJS Rev. 4(12).
6. Karkhur Y, et al. 2018. A comparative analysis of femoral nerve block with adductor canal block following total knee arthroplasty: a systematic literature review. J Anaesthesiol Clin Pharmacol. 34(4):433-438.

Block Anesthesiologist: Jeremy Wong, M.D.
Synopsis: Jose Enrique Lagueras Garcia, M.D.
Production: Sandy Thammasithiboon, M.D. / ST Film

Adductor Canal Block

A reasonable alternative option for postoperative pain relief other than a femoral nerve block. This technique can be used for:
-Lower leg, foot and ankle surgery in combination with a popliteal-sciatic nerve block
-Knee procedures (Arthroscopy, Patellar surgery, ACL, MCL Reconstruction)

Benefits of adductor canal block1
-Targeted sensory blockade
-Limited quadriceps weakness to facilitate ambulation and postoperative rehabilitation
-Easier assessment of possible compartment syndrome

Unique Contraindications:
-None other than contraindications possible with other peripheral nerve blocks

Unique Complications:
Neuropathy
-Occurs in 6% of patients2
-Symptoms include electric shock sensation at the area innervated and paresthesia. Most patient recover within 3 weeks.2
Vascular puncture
-Only 1 reported case of iatrogenic pseudoaneurysm during an ultrasound-guided catheter placement3
Systemic toxicity of local anesthetics4
-Incidence of LAST in 12,000 ultrasound-guided blocks was 0.08 per 1,000 blocks5

Technique:
Position probe at transverse position to the longitudinal axis of the thigh approximately halfway between the anterior superior iliac spine and the patella (mid-thigh level).

Identify the visible pulsation of the femoral artery, vein just inferior to it and the saphenous nerve just lateral to the artery.6
-Before needle insertion, do a thorough ultrasound examination of the femoral artery and its distributions to detect possible anatomic variations for prevention of vascular puncture.3

Identify the borders of the adductor canal: sartorius muscle anteriorly, vastus medialis posterolaterally and adductor longus posteromedially

At our institution, we normally use 5-15 ml of Ropivacaine 0.5%, depending on whether the block used was in combination with a popliteal-sciatic block for foot and ankle surgery or as a sole block for knee surgery.

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