Adductor canal block is useful but does not achieve a complete block of the knee.

نویسندگان

  • Christian Egeler
  • Aravindh Jayakumar
  • Simon Ford
چکیده

W e congratulate Kwofie et al 1 on their thorough study on the motor effects after adductor canal block (ACB). The authors found no motor weakness after ACB in healthy volunteers using a relatively high volume of local anesthetic. The injection was made at a point considered distal to the motor supply to the quad-riceps femoris muscle. However, the motor branch to the vastus medialis muscle continues within the adductor canal and is therefore likely to be affected, particularly when high volumes are used (Fig. 1). Although no clinical effect may be apparent in healthy volunteers, in patients undergoing knee arthroplasty with well-recognized reduced quadriceps function, it is possible this effect will become more significant, thus requiring further study. In our own practice, we use 5 mL of 0.5% levobupivacaine to perform an ACB as part of a motor-sparing knee block. 2 Some patients indeed demonstrate a degree of quadriceps weakness post-operatively not fully explained by bandaging, pain, or swelling. A number of studies have been published on the use of ACB for knee ar-throplasty surgery. 3,4 The authors state that a more complete knee block may be achieved with a midthigh approach to the adductor canal to more reliably block the infrapatellar nerve (IPN). We agree with this observation based on the published variability of the IPN 5 and our own cadaveric work, where we also found the IPN to be completely separate from the saphenous nerve or inferior femoral nerve. The midthigh approach to the ACB, as stated, also blocks the obturator branches traversing the distal part of the adductor canal to go on and supply the posteromedial aspect of the knee. Not mentioned in the article is the motor branch to the vastus medialis muscle, which continues to supply the medial knee capsule (Fig. 1) and, therefore, is desirable to block. As the aforementioned nerves supply only a small aspect of the knee joint, complete blockade of the knee joint requires that the genicular nerves (GNs) be blocked. These arise posteriorly from the tibial and common fibular nerve, forming a network with femoral and obturator nerve fibers and are located at the 4 corners of the knee and medially at the joint level accompanying the arterial supply to the knee. 6 Genicular nerve block can be performed using our recently described technique. 2 This still leaves the posterior capsule unaffected, which can be blocked by placing local …

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عنوان ژورنال:
  • Regional anesthesia and pain medicine

دوره 39 1  شماره 

صفحات  -

تاریخ انتشار 2014