Top

Surgical and Radiologic Anatomy

Published in:

01-11-2018 | Original Article

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

Authors: S. Kendir, Bilge İpek Torun, T. Akkaya, A. Comert, E. Tuccar, I. Tekdemir

Published in: Surgical and Radiologic Anatomy | Issue 11/2018

Abstract

Purpose

The aim of this study is to re-define the anatomical structures which are important for blocking the sciatic nerve and the nerves within the adductor canal which innervate the knee joint through the same injection site. We also aimed to investigate the spread of the anesthetic toward the areas in which the mentioned nerves lie on cadavers.

Methods

This study was performed on 16 lower extremities of formaldehyde-embalmed eight adult cadavers. The anatomy of adductor canal, courses of the nerves within the canal and the relationships of the saphenous, medial femoral cutaneous, medial retinacular, posterior branch of the obturator and sciatic nerves with each other and with the fascial compartments were investigated. Transverse sections that crossed the superior border of vastoadductor membrane were taken to reach the sciatic nerve in the shortest way. Colored latex was injected to demonstrate the anesthetic blockage of the targeted nerves. The structures along the needle’s way were investigated.

Results

The saphenous, medial femoral cutaneous and at its distal part posterior branch of the obturator nerve were colored with latex within the adductor canal. The nerve to vastus medialis (in other words, the medial retinacular nerve) lay beneath the fascia of vastus medialis and did not enter the adductor canal. There was a fascial plane which did not allow the passage of colored latex toward the sciatic nerve. To traverse this fascial structure, it was found out to be necessary to insert the needle perpendicular to both the vertical and transverse axes of the thigh and then advance it along 2/3 of diameter of the thigh. Thus, the colored latex was observed to fill the compartment where the sciatic nerve lay within.

Conclusions

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.

Abdallah FW, Whelan DB, Chan VW, Prasad GA, Endersby RV, Theodoropolous J, Oldfield S, Oh J, Brull R (2016) Adductor canal block provides non inferior analgesia and superior quadriceps strength compared with femoral nerve block in anterior cruciate ligament reconstruction. Anesthesiology 124(5):1053–1064. https://doi.org/10.1097/ALN.0000000000001045 CrossRefPubMed

Andersen HL, Andersen SL, Tranum-Jensen J (2012) Injection inside the paraneural sheath of the sciatic nerve: direct comparison among ultrasound imaging, macroscopic anatomy, and histologic analysis. Reg Anesth Pain Med 37(4):410–414. https://doi.org/10.1097/AAP.0b013e31825145f3 CrossRefPubMed

Andersen HL, Andersen SL, Tranum-Jensen J (2015) The spread of injectate during saphenous nerve block at the adductor canal: a cadaver study. Acta Anaesthesiol Scand 59(2):238–245. https://doi.org/10.1111/aas.12451 CrossRefPubMed

Bauer MC, Pogatzki-Zahn EM, Zahn PK (2014) Regional analgesia techniques for total knee replacement. Curr Opin Anaesthesiol 27(5):501–506. https://doi.org/10.1097/ACO.0000000000000115 CrossRefPubMed

Bendtsen TF, Moriggl B, Chan V, Børglum J (2015) Basic topography of the saphenous nerve in the femoral triangle and the adductor canal. Reg Anesth Pain Med 40(4):391–392. https://doi.org/10.1097/AAP.0000000000000261 CrossRefPubMed

Bendtsen TF, Moriggl B, Chan V, Børglum J (2016) The optimal analgesic block for total knee arthroplasty. Reg Anesth Pain Med 41(6):711–719CrossRef

Bendtsen TF, Moriggl B, Chan V, Pedersen EM, Børglum J (2014) Defining adductor canal block. Reg Anesth Pain Med 39(3):253–254. https://doi.org/10.1097/AAP.0000000000000052 CrossRefPubMed

Bendtsen TF, Moriggl B, Chan V, Pedersen EM, Børglum J (2014) Redefining the adductor canal block. Reg Anesth Pain Med 39(5):442–443. https://doi.org/10.1097/AAP.0000000000000119 CrossRefPubMed

Burckett LDS, Peng P, Girón AL, Niazi AU, Chan VW, Agur A, Perlas A (2016) The nerves of the adductor canal and the innervation of the knee: an anatomic study. Reg Anesth Pain Med 41(3):321–327. https://doi.org/10.1097/AAP.0000000000000389 CrossRef

10.

Charous MT, Madison SJ, Suresh PJ, Sandhu NS, Loland VJ, Mariano ER, Donohue MC, Dutton PH, Ferguson EJ, Ilfeld BM (2011) Continuous femoral nerve blocks: varying local anesthetic delivery method (bolus versus basal) to minimize quadriceps motor block while maintaining sensory block. Anesthesiology 115(4):774–781. https://doi.org/10.1097/ALN.0b013e3182124dc6 CrossRefPubMedPubMedCentral

11.

Cunningham DJ, Romanes GJ (1981) Cunningham’s textbook of anatomy. Oxford University Press, New York

12.

Davis JJ, Bond TS, Swenson JD (2009) Adductor canal block: more than just the saphenous nerve? Reg Anesth Pain Med 34(6):618–619. https://doi.org/10.1097/AAP.0b013e3181bfbf00 CrossRefPubMed

13.

Egeler C, Jayakumar A, Ford S (2013) Motor—sparing knee block—description of a new technique. Anaesthesia 68(5):542–543. https://doi.org/10.1111/anae.12233 CrossRefPubMed

14.

Faiz O, Moffat DB (2006) Anatomy at a glance. Blackwell, United States

15.

Floch H, Naux E, Pham Dang C, Dupas B, Pinaud M (2003) Computed tomography scanning of the sciatic nerve posterior to the femur: practical implications for the lateral mid femoral block. Reg Anesth Pain Med 28(5):445–449PubMed

16.

Gautier PE, Lecoq JP, Vandepitte C, Harstein G, Brichant JF (2015) Impairment of sciatic nerve function during adductor canal block. Reg Anesth Pain Med 40(1):85–89. https://doi.org/10.1097/AAP.0000000000000180 CrossRefPubMed

17.

Henningsen MH, Jaeger P, Hilsted KL, Dahl JB (2013) Prevalence of saphenous nerve injury after adductor –canal- blockade in patients receiving total knee arthroplasty. Acta Anaesthesiol Scand 57(1):112–117. https://doi.org/10.1111/j.1399-6576.2012.02792.x CrossRefPubMed

18.

Hilton J (1891) Rest and pain. A course of lectures, 2nd edn. P. W. Garfield, Cincinnati

19.

Horner G, Dellon AL (1994) Innervation of the human knee joint and implications for surgery. Clin Orthop Relat Res 301:221–226

20.

Ilfeld BM, Duke KB, Donohue MC (2010) The association between lower extremity continuous peripheral nerve blocks and patient falls after knee and hip arthroplasty. Anesth Analg 111(6):1552–1554. https://doi.org/10.1213/ANE.0b013e3181fb9507 CrossRefPubMedPubMedCentral

21.

Ilfeld BM, Mariano ER, Girard PJ, Loland VJ, Meyer RS, Donovan JF, Pugh GA, Le LT, Sessler DI, Shuster JJ, Theriaque DW, Ball ST (2010) A multicenter, randomized, triple-masked, placebo—controlled trial of the effect of ambulatory continuous femoral nerve blocks on discharge—readiness following total knee arthroplasty in patients on general orthopaedic wards. Pain 150(3):477–484. https://doi.org/10.1016/j.pain.2010.05.028 CrossRefPubMedPubMedCentral

22.

Jenstrup MT, Jæger P, Lund J, Fomsgaard JS, Bache S, Mathiesen O, Larsen TK, Dahl JB (2012) Effects of adductor –canal- blockade on pain and ambulation after total knee arthroplasty: a randomized study. Acta Anaesthesiol Scand 56(3):357–364. https://doi.org/10.1111/j.1399-6576.2011.02621.x CrossRefPubMed

23.

Karmakar M, Li X, Li J, Sala-Blanch X, Hadzic A, Gin T (2012) Three-dimensional/four-dimensional volumetric ultrasound imaging of the sciatic nerve. Reg Anesth Pain Med 37(1):60–66. https://doi.org/10.1097/AAP.0b013e318232eb92 CrossRefPubMed

24.

Karmakar MK, Kwok WH, Ho AM, Tsang K, Chui PT, Gin T (2007) Ultrasound-guided sciatic nerve block: description of a new approach at the subgluteal space. Br J Anaesth 98(3):390–395CrossRef

25.

Karmakar MK, Shariat AN, Pangthipampai P, Chen J (2013) High-definition ultrasound imaging defines the paraneural sheath and the fascial compartments surrounding the sciatic nerve at the popliteal fossa. Reg Anesth Pain Med 38(5):447–451. https://doi.org/10.1097/AAP.0b013e31829ffcb4 CrossRefPubMed

26.

Karnawat R, Gupta M (2015) Adductor canal block for post-operative pain relief in knee surgeries: a review article. J Anesth Clin Res. https://doi.org/10.4172/2155-6148.1000578 CrossRef

27.

Kirkpatrick JD, Sites BD, Antonakakis JG (2010) Preliminary experience with a new approach to performing an ultrasound-guided saphenous nerve block in the mid to proximal femur. Reg Anesth Pain Med 35(2):222–223. https://doi.org/10.1097/AAP.0b013e3181d24589 CrossRefPubMed

28.

Kwofie MK, Shastri UD, Gadsden JC, Sinha SK, Abrams JH, Xu D, Salviz EA (2013) The effects of ultrasound-guided adductor canal block versus femoral nerve block on quadriceps strength and fall risk: a blinded, randomized trial of volunteers. Reg Anesth Pain Med 38(4):321–325. https://doi.org/10.1097/AAP.0b013e318295df80 CrossRefPubMed

29.

Lund J, Jenstrup MT, Jaeger P, Sørensen AM, Dahl JB (2011) Continuous adductor -canal- blockade for adjuvant post-operative analgesia after major knee surgery: preliminary results. Acta Anaesthesiol Scand 55(1):14–19. https://doi.org/10.1111/j.1399-6576.2010.02333.x CrossRefPubMed

30.

Marian AA, Ranganath Y, Bayman EO, Senasu J, Brennan TJ (2015) A comparison of 2 ultrasound-guided approaches to the saphenous nerve block: adductor canal versus distal transsartorial: a prospective, randomized, blinded, non inferiority trial. Reg Anesth Pain Med 40(5):623–630. https://doi.org/10.1097/AAP.0000000000000277 CrossRefPubMed

31.

Pepper AM, North TW, Sunderland AM, Davis JJ (2016) Intraoperative adductor canal block for augmentation of periarticular injection in total knee arthroplasty: a cadaveric study. J Arthroplasty 31(9):2072–2076. https://doi.org/10.1016/j.arth.2016.02.030 CrossRefPubMed

32.

Runge C, Moriggl B, Børglum J, Bendtsen TF (2017) The spread of ultrasound-guided injectate from the adductor canal to the genicular branch of the posterior obturator nerve and the popliteal plexus: a cadaveric study. Reg Anesth Pain Med 42(6):725–730. https://doi.org/10.1097/AAP.0000000000000675 CrossRefPubMed

33.

Sankineani SR, Reddy ARC, Eachempati KK, Jangale A, Gurava Reddy AV (2018) Comparison of adductor canal block and IPACK block (interspace between the popliteal artery and the capsule of the posterior knee) with adductor canal block alone after total knee arthroplasty: a prospective control trial on pain and knee function in immediate postoperative period. Eur J Orthop Surg Traumatol. https://doi.org/10.1007/s00590-018-2218-7 CrossRefPubMed

34.

Sato K, Adachi T, Shirai N, Naoi N (2014) Continuous versus single-injection sciatic nerve block added to continuous femoral nerve block for analgesia after total knee arthroplasty: a prospective, randomized, double-blind study. Reg Anesth Pain Med 39(3):225–229. https://doi.org/10.1097/AAP.0000000000000076 CrossRefPubMed

35.

Slover J, Riesgo A, Payne A, Umeh U (2014) Modern anesthesia for total joint arthroplasty. Ann Orthop Rheumatol 2(3):1026

36.

Snell R (2012) Clinical anatomy by regions. In: Chapter 10 (The lower limb), 9th edn. Wolters Kluwer/Lippincott Williams&Wilkins, Philadelphia, pp 465–466

37.

Standring S (2016) Gray’s anatomy: the anatomical basis of clinical practice. In: Section 9 (Pelvic girdle and lower limb): Chap. 80 (Pelvic girdle, gluteal region and thigh), Chap. 81 (Hip), 41st edn. Elsevier Churchill Livingstone, New York, pp 1366–1379

38.

Stevens JE, Mizner RL, Snyder-Mackler L (2003) Quadriceps strength and volitional activation before and after total knee arthroplasty for osteoarthritis. J Orthop Res 21(5):775–779CrossRef

39.

Stoller DW (2007) Magnetic resonance imaging in orthopaedics and sports medicine, 3rd edn. Wolters Kluwer/Lippincott Williams&Wilkins, Philadelphia

Title: Re-defining the anatomical structures for blocking the nerves in adductor canal and sciatic nerve through the same injection site: an anatomical study
Authors: S. Kendir
Bilge İpek Torun
T. Akkaya
A. Comert
E. Tuccar
I. Tekdemir
Publication date: 01-11-2018
Publisher: Springer Paris
Published in: Surgical and Radiologic Anatomy / Issue 11/2018
Print ISSN: 0930-1038
Electronic ISSN: 1279-8517
DOI: https://doi.org/10.1007/s00276-018-2094-1

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

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

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 11/2018

Morphological variability of the palmaris longus muscle in human fetuses

Organization of the fascia and aponeurosis in the lumbar paraspinal compartment

Tegmento-vermian dysplasia: radiologic features of a novel described anatomic variation

Fractal anatomy of the hippocampal formation

A sectional anatomy learning tool for medical students: development and user–usage analytics

Stereoscopic visual area connectivity: a diffusion tensor imaging study