Intraoperative Adductor Canal Block for Augmentation of Periarticular Injection in Total Knee Arthroplasty: A Cadaveric Study

Pepper, Andrew M; North, Trevor; Sunderland, Adam M.; Davis, Jason J.

doi:10.1016/j.arth.2016.02.030

Cited by 22 publications

(18 citation statements)

References 38 publications

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“…Hence, there seems to be a clear benefit in combining PAI and ACB through the same intraoperative route to economise on costs and save time; thus, making it more efficient. A similar study on cadaveric knees by Pepper et al also showed that an intraoperative DACB block at the distal location is feasible through the knee joint [13]. However, they studied the procedure on native knee joints without prosthetic implants.…”

Section: Discussionmentioning

confidence: 94%

“…Since the ACB under USG is administered by an anaesthesiologist, the associated factors, such as time, economy and skill, may potentially limit its widespread use by the surgeons. Recently, Pepper et al have studied the feasibility of a surgeon-administered direct adductor canal block (DACB) in cadaveric knees [13]. It is postulated that a DACB can be effectively and safely performed, without any additional USG and is based on the anatomic location of the adductor canal.…”

Section: Introductionmentioning

confidence: 99%

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The feasibility of direct adductor canal block (DACB) as a part of periarticular injection in total knee arthroplasty

Bagaria

Kulkarni

Valavi

et al. 2020

Knee Surg & Relat Res

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Background Adductor canal block (ACB) is one of the preferred methods of analgesia in total knee arthroplasty (TKA). However, conventionally its use is time-consuming, requires ultrasound guidance, a trained anaesthesia team and adherence to strict asepsis by members of the allied teams. This study was done to assess the feasibility and safety of direct adductor canal block (DACB) as a part of surgeon-administered periarticular infiltration. Materials and methods Thirty computed tomography (CT) angiography films of the patients were retrospectively reviewed. The trajectory of the needle placement for a DACB in relation to the target region of the adductor block was determined. Fourteen knees in seven cadavers, were dissected through a medial parapatellar approach to perform TKA. After administering the DACB using the technique based on CT data, dissection was carried out to ascertain the correct placement of the dye by visualising the stained areas. Results The angle of approach in the coronal plane from the entry point to the medial high point and to the adductor hiatus was 10.2° (8−14°) and 6° (3.8−11°), respectively. The angle of approach in the sagittal plane from the entry point to the medial high point and to the adductor hiatus was 7° (5−10.5°) and 29° (19−43°), respectively. In all the 14 cadaveric knees, we confirmed the correct placement of the methylene blue dye as demonstrated by the staining of the adductor canal. Conclusion The study demonstrates the feasibility of the DACB. This surgeon-driven technique is likely to reduce the cost of the procedure, reduce operating room time and also eliminate the risks of surgical-site contamination.

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Section: Discussionmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 99%

The feasibility of direct adductor canal block (DACB) as a part of periarticular injection in total knee arthroplasty

Bagaria

Kulkarni

Valavi

et al. 2020

Knee Surg & Relat Res

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“…Intraoperatively, a periarticular injection of 120 mL of diluted ropivacaine 300 mg with epinephrine 1 mg and ketorolac 30 mg was used for local administration. Intraoperative surgeon-delivered adductor canal blockade with 20 mL of the cocktail was added as previously described [24] . The postoperative pain regimen consisted of sustained-release morphine 15 mg every 8 hours for 24 hours, meloxicam 15 mg daily, gabapentin 300 mg twice daily, scheduled oral acetaminophen 975 mg every 8 hours, scheduled tramadol 50 mg every 6 hours, and oxycodone 5-10 mg as needed with morphine 1-2 mg intravenously for breakthrough pain.…”

Section: Methodsmentioning

confidence: 99%

Time of return of neurologic function after spinal anesthesia for total knee arthroplasty: mepivacaine vs bupivacaine in a randomized controlled trial

et al. 2019

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Background Mepivacaine as an intermediate-length spinal anesthetic for rapid recovery in total knee arthroplasty (TKA) has not been fully described. We compared spinal mepivacaine vs bupivacaine for postoperative neurologic function in patients undergoing primary TKA. Methods Thirty-two patients undergoing primary TKA were enrolled. Primary outcome measure was return of motor and sensory function. Secondary outcome measures included assessment of urinary function, pain via visual analog scale (VAS) scores, opioid usage, distance walked and pain with physical therapy, time to discharge readiness, and complications. Results Patients with mepivacaine spinal anesthetic had faster return of sensory function (164 ± 38.6 vs 212 ± 54.2 minutes, P = .015), return of motor function (153 ± 47.4 vs 200 ± 45.2 minutes, P = .025), and time to straight leg raise (148 ± 43.5 vs 194 ± 50.8 minutes, P = .023). The mepivacaine group experienced significantly fewer episodes of urinary retention and shorter time to urination (344 ± 154.4 vs 416 ± 96.3 minutes, P = .039). Patients exhibited slightly higher VAS pain scores in the postanesthesia care unit (1.0 ± 1.7 vs 2.7 ± 2.3, P = .046) with no difference in opioid consumption. There were no differences in VAS scores or opioid use on the inpatient ward. Patients achieved discharge readiness 71 minutes faster in the mepivacaine group. There was no need to convert to general anesthesia or transient nerve symptoms in either group. Conclusions Patients undergoing TKA with mepivacaine spinal anesthetic had a reliably more rapid neurologic recovery after TKA compared to bupivacaine.

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“…One technique study of periarticular analgesia mentioned injection of "several milli-meters…in the region of Hunter canal," but not a specific location [11]. A study by Pepper et al [24] also studied 11 cadaveric knees and injected 10-mL aliquots of dye toward the proximal and distal adductor canal (AC) using a variety of needles. This study reported an accuracy of 86% using a blunt needle toward the "distal AC," 57% accuracy with a blunt needle in the "proximal AC," and only 14% accuracy using a spinal needle in the "proximal AC" [24].…”

Section: Discussionmentioning

confidence: 99%

“…A study by Pepper et al [24] also studied 11 cadaveric knees and injected 10-mL aliquots of dye toward the proximal and distal adductor canal (AC) using a variety of needles. This study reported an accuracy of 86% using a blunt needle toward the "distal AC," 57% accuracy with a blunt needle in the "proximal AC," and only 14% accuracy using a spinal needle in the "proximal AC" [24]. This study is limited in that the AC locations were descriptive only, and TKA bone resections and trial component implantations were not performed.…”

Section: Discussionmentioning

confidence: 99%

Saphenous Nerve Block From Within the Knee Is Feasible for TKA: MRI and Cadaveric Study

Kavolus

Sia

Potter

et al. 2018

Clin Orthop Relat Res

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Intraoperative Adductor Canal Block for Augmentation of Periarticular Injection in Total Knee Arthroplasty: A Cadaveric Study

Cited by 22 publications

References 38 publications

The feasibility of direct adductor canal block (DACB) as a part of periarticular injection in total knee arthroplasty

The feasibility of direct adductor canal block (DACB) as a part of periarticular injection in total knee arthroplasty

Time of return of neurologic function after spinal anesthesia for total knee arthroplasty: mepivacaine vs bupivacaine in a randomized controlled trial

Saphenous Nerve Block From Within the Knee Is Feasible for TKA: MRI and Cadaveric Study

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