Ultrasound-guided TQL injections consistently cover the thoraco-lumbar innervation relevant to the AIC graft donor site. The injectate spread seen in anatomical dissections correlated with the dermatomal anesthesia clinically. The TQL has the potential to provide reliable analgesia for patients undergoing AIC bone graft harvesting.

Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

There is no universally agreed set of anatomical structures that must be identified on ultrasound for the performance of ultrasound-guided regional anesthesia (UGRA) techniques. This study aimed to produce standardized recommendations for core (minimum) structures to identify during seven basic blocks. An international consensus was sought through a modified Delphi process. A long-list of anatomical structures was refined through serial review by key opinion leaders in UGRA. All rounds were conducted remotely and anonymously to facilitate equal contribution of each participant. Blocks were considered twice in each round: for “orientation scanning” (the dynamic process of acquiring the final view) and for the “block view” (which visualizes the block site and is maintained for needle insertion/injection). Strong recommendations for inclusion were made if ≥75% of participants rated a structure as “definitely include” in any round. Weak recommendations were made if >50% of participants rated a structure as “definitely include” or “probably include” for all rounds (but the criterion for “strong recommendation” was never met). Thirty-six participants (94.7%) completed all rounds. 128 structures were reviewed; a “strong recommendation” is made for 35 structures on orientation scanning and 28 for the block view. A “weak recommendation” is made for 36 and 20 structures, respectively. This study provides recommendations on the core (minimum) set of anatomical structures to identify during ultrasound scanning for seven basic blocks in UGRA. They are intended to support consistent practice, empower non-experts using basic UGRA techniques, and standardize teaching and research.

Background and objectivesThe nerve to vastus medialis (NVM) supplies sensation to important structures relevant to total knee arthroplasty via a medial parapatellar approach. There are opposing findings in the literature about the presence of the NVM within the adductor canal (AC). The objective of this cadaveric study is to compare the effect of injection site (distal femoral triangle (FT) vs distal AC) on injectate spread to the saphenous nerve (SN) and the NVM.MethodsFour unembalmed fresh-frozen cadavers acted as their own control with one thigh receiving 20 mL of dye injected via an ultrasound-guided injection in the distal FT while the other thigh received an ultrasound-guided injection in the distal AC. A standardized dissection took place 1 hour later to observe the extent of staining to the NVM and SN in all cadaver thigh specimens.ResultsIn all specimens where the injectate was introduced into the distal FT, both the SN and NVM were stained. In contrast, when the dye was administered in the distal AC only the SN was stained.ConclusionsOur findings suggest that an injection in the distal AC may be suboptimal for knee analgesia as it may spare the NVM, while an injection in the distal FT could provide greater analgesia to the knee but may result in undesirable motor blockade from spread to the nerve to vastus intermedius.

An ultrasound-guided single-injection PVB provides equivalent dermatomal spread and duration of analgesia compared with a multiple-injection PVB. The single-injection technique takes less time to perform and hence may be preferred over a multiple-injection technique.The trial was registered prospectively at ClinicalTrials.gov (NCT02852421) on July 15, 2016.