A Randomized Comparison of Proximal and Distal Ultrasound‐Guided Adductor Canal Catheter Insertion Sites for Knee Arthroplasty

Abstract

Continuous adductor canal blocks can be performed reliably at both proximal and distal locations. The proximal approach may offer minor analgesic and logistic advantages without an increase in motor block.

Comparison of Continuous Proximal Versus Distal Adductor Canal Blocks for Total Knee Arthroplasty

“…3,25 Our noninferiority margin, 12 mg, is 50% of our known institutional opioid usage and similar to prior studies using opioid use of 10 mg as a clinically relevant difference. A noninferiority margin any smaller would have limited clinical consequence.…”

Virtual reality distraction decreases routine intravenous sedation and procedure-related pain during preoperative adductor canal catheter insertion: a retrospective study

“…All patients received an ACC using a standardized technique, as described previously [10]. Briefly, after peripheral intravenous catheter insertion in the preoperative block room and positioning, standard noninvasive monitors and oxygen, via a nasal cannula, were applied to all patients.…”

“…Under ultrasound guidance (Edge HFL50x Transducer; Fujifilm Sonosite, Bothell, WA, USA) and using sterile technique, each ACC (Arrow FlexTip Plus; Teleflex Medical, Research Triangle Park, NC, USA) was inserted through a local anesthetic skin wheal and directed in-plane into the adductor canal lateral to the superficial femoral artery after an injection of 10–20 ml of 1.5% mepivacaine via the placement needle. All catheters were tunneled subcutaneously in a cephalad and lateral direction towards the anterior superior iliac spine using the placement needle and its stylet [10]. The catheter was secured with a clear occlusive dressing and an anchoring device [11].…”

Determination of ED50 and ED95 of 0.5% Ropivacaine in Adductor Canal Block to Produce Quadriceps Weakness

“…24 We performed ACB by using sonographic landmarks, which has been adopted for clinical practice at our institute for singleinjection blocks and continuous nerve block following knee surgeries. The midthigh approach used by other investigators, 13,[19][20][21]25 although slightly proximal to that of our approach, is thought to target the saphenous nerve in the femoral triangle instead of in the AC. 26 By combining the landmarks described by Horn et al 15 and Manickam et al 14 in our study, we thought that the performance of injections were reliably within the AC proper.…”