Adductor Canal Block Can Result in Motor Block of the Quadriceps Muscle

Abstract

Several studies have reported that ACB involves no motor blockade. However, our case report illustrates that the ACB can result in clinically significant quadriceps muscle paralysis. This report suggests that patients should be monitored vigilantly for this occurrence to decrease the risk of falls.

Adductor canal blockade for moderate to severe pain after arthroscopic knee surgery: a randomized controlled trial

“…The high volume of local anaesthetic used for the block is controversial as it, in theory, may cause a retrograde flow affecting motor fibres of the femoral nerve. 19,20 However, in recent studies 14,21 only minimal reductions in quadriceps muscle strength were demonstrated after injection of 30 ml ropivacaine 7.5 mg/ml. Nevertheless, in the present study, we have to account for this possibility as we administered 2 × 30 ml of study medication.…”

Recent advances in regional anaesthesia

“…There have been isolated reports of quadriceps weakness (femoral nerve block) and even the popliteal e sciatic nerve getting blocked after an adductor canal block [26,27].…”

Adductor Canal Block May Just Be an (Unreliable) Indirect Femoral Nerve Block

“…I t is with interest that we read the case report by Chen et al 1 To be successful when doing continuous peripheral nerve blocks, we must have meticulous indications for the blocks, must block the correct nerve(s), and must use the correct techniques and equipment. These requirements may well be satisfied when using an adductor canal block (ACB) for total knee arthroplasty (TKA), but according to our knowledge of the innervation of the knee joint, it is difficult to understand how we can possibly satisfy the second basic requirement of blocking the correct nerve(s).…”

“…Proximal spread to involve the entire femoral nerve, however, is undisputable. [1][2][3] The only unknown factor at this stage is how reliable this spread is. That it attracts case reports at this stage 1,3 may suggest that it is not very reliable at all.…”