Adductor canal block techniques do not lead to involvement of sciatic nerve branches: a radiological cadaveric study.

Autor:	Smulders PS; Department of Anesthesiology, Amsterdam UMC Location AMC, Amsterdam, The Netherlands., Ten Hoope W; Department of Anesthesiology, Rijnstate Hospital, Arnhem, The Netherlands., Baumann HM; Department of Anesthesiology, Amsterdam UMC Location AMC, Amsterdam, The Netherlands., Hermanides J; Department of Anesthesiology, Amsterdam UMC Location AMC, Amsterdam, The Netherlands j.hermanides@amsterdamumc.nl., Hemke R; Department of Radiology and Nuclear Medicine, Amsterdam UMC Location AMC, Amsterdam, The Netherlands., Beenen LFM; Department of Radiology and Nuclear Medicine, Amsterdam UMC Location AMC, Amsterdam, The Netherlands., Oostra RJ; Department of Medical Biology, Amsterdam UMC Location AMC, Amsterdam, The Netherlands., Marhofer P; Department of Anesthesiology, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria., Lirk P; Department of Anesthesiology, Brigham and Women's Hospital, Boston, Massachusetts, USA., Hollmann MW; Department of Anesthesiology, Amsterdam UMC Location AMC, Amsterdam, The Netherlands.
Jazyk:	angličtina
Zdroj:	Regional anesthesia and pain medicine [Reg Anesth Pain Med] 2024 Mar 04; Vol. 49 (3), pp. 174-178. Date of Electronic Publication: 2024 Mar 04.
DOI:	10.1136/rapm-2022-104227
Abstrakt:	Introduction: Low and high volume mid-thigh (ie, distal femoral triangle) and distal adductor canal block approaches are frequently applied for knee surgical procedures. Although these techniques aim to contain the injectate within the adductor canal, spillage into the popliteal fossa has been reported. While in theory this could improve analgesia, it might also result in motor blockade due to coverage of motor branches of the sciatic nerve. This radiological cadaveric study, therefore, investigated the incidence of coverage of sciatic nerve divisions after various adductor canal block techniques. Methods: Eighteen fresh, unfrozen and unembalmed human cadavers were randomized to receive ultrasound-guided distal femoral triangle or distal adductor canal injections, with 2 mL or 30 mL injectate volume, on both sides (36 blocks in total). The injectate was a 1:10 dilution of contrast medium in local anesthetic. Injectate spread was assessed using whole-body CT with reconstructions in axial, sagittal and coronal planes. Results: No coverage of the sciatic nerve or its main divisions was found. The contrast mixture spread to the popliteal fossa in three of 36 nerve blocks. Contrast reached the saphenous nerve after all injections, whereas the femoral nerve was always spared. Conclusions: Adductor canal block techniques are unlikely, even when using larger volumes, to block the sciatic nerve, or its main branches. Furthermore, injectate reached the popliteal fossa in a small minority of cases, yet if a clinical analgesic effect is achieved by this mechanism is still unknown. Competing Interests: Competing interests: None declared. (© American Society of Regional Anesthesia & Pain Medicine 2024. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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