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Adductor canal nerve block

Joseph J Kavolus, David Sia, Hollis G Potter, David E Attarian, Paul F Lachiewicz
BACKGROUND: Surgeon-performed periarticular injections and anesthesiologist-performed femoral nerve or adductor canal blocks with local anesthetic are in common use as part of multimodal pain management regimens for patients undergoing TKA. However, femoral nerve blocks risk causing quadriceps weakness and falls, and anesthesiologist-performed adductor canal blocks are costly in time and resources and may be unreliable. We investigated the feasibility of a surgeon-performed saphenous nerve ("adductor canal") block from within the knee at the time of TKA...
January 2018: Clinical Orthopaedics and related Research
Rebecca-Lea Smith, Richard Doyle
No abstract text is available yet for this article.
March 2, 2018: British Journal of Hospital Medicine
Young Uk Park, Jae Ho Cho, Doo Hyung Lee, Wan Sun Choi, Han Dong Lee, Keun Soo Kim
BACKGROUND: Single or combined multiple-site peripheral nerve blocks (PNBs) are becoming popular for patients undergoing surgery on their feet or ankles. These procedures are known to be generally safe in surgical settings compared with other forms of anesthesia, such as spinal block. The purposes of this study were to assess the incidence of complications after the administration of multiple PNBs for foot and ankle surgery and to compare the rates of complications between patients who received a single PNB and those who received multiple blocks...
January 1, 2018: Foot & Ankle International
Erdan Kayupov, Kamil Okroj, Adam C Young, Mario Moric, Timothy J Luchetti, Gilat Zisman, Asokumar Buvanendran, Tad L Gerlinger, Craig J Della Valle
BACKGROUND: Adductor canal blocks (ACBs) are an alternative to femoral nerve blocks that minimize lower extremity weakness. However, it is unclear whether this block will provide analgesia that is equivalent to techniques, such as epidural analgesia. The purpose of this randomized controlled trial was to compare continuous ACBs with epidural analgesia for primary total knee arthroplasty. METHODS: Following institutional review board approval, 145 patients were randomized to 1 of 3 groups: combined spinal-epidural (CSE), spinal + continuous ACB (CACB), or general + CACB...
November 13, 2017: Journal of Arthroplasty
Ryan R Thacher, Thomas R Hickernell, Matthew J Grosso, Roshan Shah, Herbert J Cooper, Robert Maniker, Anthony Robin Brown, Jeffrey Geller
Background: Femoral nerve (FNB) and adductor canal blocks (ACB) are used in the setting of total knee arthroplasty (TKA), but neither has been demonstrated to be clearly superior. Although dynamometer studies have shown ACBs spare perioperative quadriceps function when compared to FNBs, ACBs have been widely adopted in orthopaedic surgery without significant evidence that they decrease the risk of perioperative falls. Methods: All patients who received single-shot FNB (129 patients) or ACB (150 patients) at our institution for unilateral primary TKA from April 2014 to September 2015 were retrospectively reviewed for perioperative falls or near-falls during physical therapy and inpatient care...
December 2017: Arthroplasty Today
Jin-Hyeok Seo, Seung-Suk Seo, Do-Hun Kim, Byung-Yoon Park, Chan-Ho Park, Ok-Gul Kim
Purpose: We compared adductor canal block (ACB) alone and a combination of ACB and sciatic nerve block (SNB) to control early postoperative pain after total knee arthroplasty. Materials and Methods: One hundred patients received continuous ACB alone (group A), and another 100 patients received continuous ACB and single popliteal SNB (group B). Pain was evaluated at rest and 45° knee flexion using the numeric rating scale (NRS). The number of times the patient pressed the intravenous patient-controlled analgesia (PCA) button, total PCA volume infused, and the total dosage of additional analgesics were evaluated...
December 1, 2017: Knee Surgery & related Research
James E Christensen, Natalie E Taylor, Scott J Hetzel, John A Shepler, Tamara A Scerpella
Background: Recent evidence shows a delayed return to sport in children and delayed quadriceps recovery in both adults and children who have undergone anterior cruciate ligament (ACL) reconstruction with concomitant femoral nerve blockade (FNB) compared with those who had no blockade. We evaluated the use of adductor canal blockade (ACB), as an alternative to FNB, at the time of ACL reconstruction. Hypothesis: Patients who receive ACB will have greater isokinetic strength at 6 months postoperative compared with patients who receive FNB at the time of ACL reconstruction...
November 2017: Orthopaedic Journal of Sports Medicine
Herman Sehmbi, Richard Brull, Ushma Jitendra Shah, Kariem El-Boghdadly, David Nguyen, Girish P Joshi, Faraj W Abdallah
BACKGROUND: Adductor canal block (ACB) has emerged as an effective analgesic regional technique for major knee surgeries in the last decade. Its motor-sparing properties make it particularly attractive for ambulatory knee surgery, but evidence supporting its use in ambulatory arthroscopic knee surgery is conflicting. This systematic review and meta-analysis evaluates the analgesic effects of ACB for ambulatory arthroscopic knee surgeries. METHODS: We conducted a comprehensive search of electronic databases for randomized controlled trials examining the analgesic effects of ACB compared to control or any other analgesic modality...
October 19, 2017: Anesthesia and Analgesia
Cun-Jin Wang, Feng-Yun Long, Liu-Qing Yang, You-Jing Shen, Fang Guo, Tian-Feng Huang, Ju Gao
Adductor canal block (ACB) is an effective analgesic alternative to femoral nerve block after total knee arthroplasty (TKA). The aim of the present study was to investigate whether addition of dexamethasone to ropivacaine for ACB is able to prolong analgesia and reduce pain. Study participants were randomized into groups receiving ACB with either 0.5% ropivacaine + normal saline (control group; n=93) or 0.5% ropivacaine + 8 mg dexamethasone (dexamethasone group; n=93). All patients were subjected to identical peri-operative management...
October 2017: Experimental and Therapeutic Medicine
Salman Thobhani, Lauren Scalercio, Clint E Elliott, Bobby D Nossaman, Leslie C Thomas, Dane Yuratich, Kim Bland, Kristie Osteen, Matthew E Patterson
BACKGROUND: Novel regional techniques, including the adductor canal block (ACB) and the local anesthetic infiltration between the popliteal artery and capsule of the knee (IPACK) block, provide an alternative approach for controlling pain following total knee arthroplasty (TKA). This study compared 3 regional techniques (femoral nerve catheter [FNC] block alone, FNC block with IPACK, and ACB with IPACK) on pain scores, opioid consumption, performance during physical therapy, and hospital length of stay in patients undergoing TKA...
2017: Ochsner Journal
Charlotte Runge, Bernhard Moriggl, Jens Børglum, Thomas Fichtner Bendtsen
BACKGROUND AND OBJECTIVES: The popliteal nerve plexus contributes to afferent knee-pain conduction. It is mainly formed by genicular branches from the posterior obturator and the tibial nerves, innervating the intra-articular and posterior knee region. A subinguinal obturator nerve block alleviates pain after total knee arthroplasty. Reduced hip adductor motor function could be avoided by a posterior obturator nerve block inside the popliteal fossa.The aim of this study was to evaluate the spread of dye after a distal adductor canal (AC) injection to the popliteal fossa and coloring of the popliteal plexus and the genicular branch of the posterior obturator nerve by dissection...
November 2017: Regional Anesthesia and Pain Medicine
Jakob Hessel Andersen, Pia Jaeger, Tobias Laier Sonne, Jørgen Berg Dahl, Ole Mathiesen, Ulrik Grevstad
BACKGROUND: Clonidine used as an adjuvant to ropivacaine have been shown to prolong the duration of peripheral nerve blocks. The mechanism of action remains unclear. We hypothesized, that clonidine used as an adjuvant to ropivacaine extends the duration of an adductor canal block (ACB) by a peripheral mechanism, compared to ropivacaine alone when controlling for systemic effects. METHODS: We conducted a paired, blinded, randomized trial in healthy volunteers. Participants received bilateral ACBs containing 20 ml ropivacaine 0...
2017: PloS One
Poupak Rahimzadeh, Hamid Reza Faiz, Farnad Imani, Geoffrey Grant Hobika, Armaghan Abbasi, Nader D Nader
OBJECTIVE: To compare the analgesic effects of femoral nerve block (FNB) and adductor canal block (ACB) after arthroscopic knee surgery. METHODS: This was a prospective randomised clinical trial that enrolled 92 patients undergoing arthroscopic knee surgery. Ultrasound-guided FNB or ACB was performed immediately after surgery for pain relief. Visual analogue scale (VAS) scores and modified sedation-agitation scale (SAS) were recorded and analysed immediately following block and at 3, 6, 12 and 24 hours...
August 2017: Turkish Journal of Anaesthesiology and Reanimation
Seung Suk Seo, Ok Gul Kim, Jin Hyeok Seo, Do Hoon Kim, Youn Gu Kim, Beyoung Yun Park
BACKGROUND: This study aimed to compare the effects of femoral nerve block and adductor canal block on postoperative pain, quadriceps strength, and walking ability after primary total knee arthroplasty. METHODS: Between November 2014 and February 2015, 60 patients underwent primary total knee arthroplasty. Thirty patients received femoral nerve block and the other 30 received adductor canal block for postoperative pain control. Before spinal anesthesia, the patients received nerve block via a catheter (20 mL 0...
September 2017: Clinics in Orthopedic Surgery
Nicolas Rousseau-Saine, Stephan R Williams, François Girard, Luc J Hébert, Florian Robin, Luc Duchesne, Frédéric Lavoie, Monique Ruel
BACKGROUND: Total knee arthroplasty (TKA) reduces knee extensor muscle strength (KES) in the operated limb for several months after the surgery. Immediately after TKA, compared to either inguinal femoral nerve block or placebo, adductor canal block (ACB) better preserves KES. Whether this short-term increase in KES is maintained several weeks after surgery remains unknown. We hypothesized that 48 hours of continuous ACB immediately after TKA would improve KES 6 weeks after TKA, compared to placebo...
March 2018: Anesthesia and Analgesia
Olawale A Sogbein, Rakesh V Sondekoppam, Dianne Bryant, David F Johnston, Edward M Vasarhelyi, Steven MacDonald, Brent Lanting, Sugantha Ganapathy, James L Howard
BACKGROUND: Pain following total knee arthroplasty (TKA) is often severe and can inhibit rehabilitation. Motor-sparing analgesic techniques such as periarticular infiltrations and adductor canal blocks have been popularized for knee analgesia since they preserve motor strength and permit early mobilization. Our primary objective was to compare the duration of analgesia from motor-sparing blocks with that of a standard periarticular infiltration. We used the time to first rescue analgesia as the end point...
August 2, 2017: Journal of Bone and Joint Surgery. American Volume
David F Johnston, Rakesh V Sondekoppam, Vishal Uppal, James L Howard, Sugantha Ganapathy
This narrative review article aims to examine current evidence of knee innervation in order to develop a technique of targeting pure sensory innervation of the knee joint without compromising motor function. A literature review of knee innervation was performed to gain an anatomic understanding of terminal sensory branches of the relevant target nerves (femoral, obturator, sciatic, and lateral femoral cutaneous). Pure sensory block of the knee joint is challenging due to important contributions from the muscular innervation close to the joint and the variability of nerves afferents contained within and around the adductor canal...
June 14, 2017: Clinical Journal of Pain
Ming-Jie Kuang, Jian-Xiong Ma, Lin Fu, Wei-Wei He, Jie Zhao, Xin-Long Ma
BACKGROUND: Total knee arthroplasty (TKA) is associated with intense postoperative pain with a need for early ambulation to gain function and prevent postoperative complications. Compared with femoral nerve block (FNB), adductor canal block (ACB) can relieve postoperative pain and preserve quadriceps muscle strength. This meta-analysis was conducted to investigate which analgesic method provides better pain relief and functional recovery after TKA. METHOD: We conducted a meta-analysis to identify relevant randomized controlled trials involving ACB and FNB after TKA in electronic databases, including Web of Science, Embase, PubMed, and the Cochrane Library, up to November 2016...
October 2017: Journal of Arthroplasty
In Jun Koh, Young Jun Choi, Man Soo Kim, Hyun Jung Koh, Min Sung Kang, Yong In
Inadequate pain management after total knee arthroplasty (TKA) impedes recovery, increases the risk of postoperative complications, and results in patient dissatisfaction. Although the preemptive use of multimodal measures is currently considered the principle of pain management after TKA, no gold standard pain management protocol has been established. Peripheral nerve blocks have been used as part of a contemporary multimodal approach to pain control after TKA. Femoral nerve block (FNB) has excellent postoperative analgesia and is now a commonly used analgesic modality for TKA pain control...
June 1, 2017: Knee Surgery & related Research
Eman Elazab Beheiry Elazab
The precise description of the fascia vasto-adductoria (FVA) has become an issue of great surgical and clinical importance. Neurovascular entrapment within the adductor canal (AC) may simulate many clinical conditions for cases presented with medial knee or leg pain and ischemic manifestations of the leg. The aim of the present work is to describe the morphological features of the FVA and to elucidate its neurovascular relations. Forty thigh specimens, pertaining to 15 embalmed and five fresh adult human cadavers, were dissected in pursuit of this aim...
October 2017: Surgical and Radiologic Anatomy: SRA
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