The iliopsoas, passing into the thigh beneath the inguinal liga ment, assists along with the pectineus and adductor muscles in forming the. It is located at the level of the carpal bones, and best seen when the thumb is extended in the past, this depression was used to hold snuff ground tobacco before inhaling via the nose hence it was given the name snuffbox. Pdf defining the location of the adductor canal using ultrasound. Adductor canal subsartorial canal linkedin slideshare. Adductor canal article about adductor canal by the free. The adductor canal block is a technique for providing analgesia of the knee region without compromising ambulation and disposition. In the proximal thigh, the saphenous nerve often lies anterior to the femoral artery as this vessel passes beneath the sartorius muscle, and posterior to the aponeurotic covering of the adductor canal.
The adductor canal subsartorial or hunters canal is an aponeurotic tunnel in the middle third of the thigh, extending from the apex of the femoral triangle to the opening in the adductor magnus, the adductor hiatus. It acts as a pathway by which structures can pass from the abdominal wall to the external genitalia. Adductor canal block versus femoral nerve block for total. This video is of an ultrasoundguided adductor canal block acb. We know now that it is not and lies outside of the canal. Adductor canal definition of adductor canal by medical. The nerve exits psoas major at the lower part of its lateral border, passing. Singledose adductor canal block with local infiltrative. Although they are all located somewhere along the medial side of the thigh, they all originate in different places at the front of the pelvis. Adductor hiatus definition of adductor hiatus by medical. We report a case of a 55yearold male who was diagnosed with the adductor canal compression syndrome a rarely described nontraumatic disorder of.
The purpose of this prospective study is to examine the effect of two local anesthetics used in adductor canal blocks, with relation to pain, analgesic consumption, mobility, and pain. The femoral triangle is a region found at the medial aspect of the upper thigh 3. The comparison of adductor canal block with femoral nerve. It runs parallel to the great saphenous vein in the leg and supplies the skin of the anteromedial leg, ankle and foot.
This block could cause nerve injury and the aim of this followup study was to determine the prevalence of saphenous nerve injury in patients receiving adductor canal blockade for pain treatment after total knee arthroplasty. Adductor canal block is a promising alternative to femoral nerve block for belowknee procedures because it allows for better preservation of the muscle strength of the quadriceps. Ta the aperture in the aponeurotic insertion of the adductor magnus that transmits the femoral artery and vein from the adductor canal to the popliteal space. The inguinal canal is a short passage that extends inferiorly and medially, through the inferior part of the abdominal wall. The block has become popularized as a way of providing analgesia to the knee and medial portion of the lower leg while avoiding quadriceps weakness, which is common with the femoral nerve block. The entrance to the femoral canal is the femoral ring, through which bowel can sometimes enter, causing a femoral hernia. Many of our members get femoral blocks along with their spinal anesthetic. Kim dh1, lin y, goytizolo ea, kahn rl, maalouf db, manohar a, patt ml, goon ak, lee yy, ma y, yadeau jt. The adductor canal block acb, or more precisely the saphenous nerve block in the adductor canal, is a singleshot or continuous technique for anesthesia and analgesia of the knee and medial leg. The lateral border is the thick fascia of the vastus medialis. Ultrasound guided adductor canal block versus femoral nerve.
Nov 25, 2014 this feature is not available right now. Contents the adductor canal serves as a passageway from structures moving between the anterior thigh and posterior leg. The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Early ambulation is not generally limited with the use of femoral block, and the theoretical advantage of adductor canal block being muscle sparring was not observed in our study probably due to its suboptimal pain control. It is a cutaneous nerve that travels in the adductor canal but exits proximal to the adductor hiatus. Types of activities reading physiopedia pages, journal articles, book chapters. The adductorcanalblockade is theoretically an almost pure sensory blockade.
The effects of ultrasoundguided adductor canal block. The adductor canal is the space in the middle third of thigh between vastus medialis and the. The adductor canal borders contents teachmeanatomy. The positive impact of regional anesthesia on surgical outcome has continued to evolve. The adductor canal runs from the apex of the femoral triangle to the adductor hiatus a. Anatomy front of the thigh adductor canal part 7 dr. Liposomal bupivacaine vs adductor canal block in total knee.
Adductor canal is 15cm long and stretches from the apex of the femoral triangle, above, to the tendinous opening in the adductor magnus, below. Straight from the powerpoints and readings mostly charts in the book learn with flashcards, games, and more for free. The adductor canal canalis adductorius, hunters canal, subsartorial canal is a musculoaponeurotic tunnel in the middle third of the thigh, extending from the distal apex of the femoral triangledefined by the crossing of the medial margin of the adductor longus muscle and the medial margin of the sartorius muscleto the adductor hiatus, an opening in the adductor magnus 1, 2. The library is located on the 8th floor of the hospitals main building. Defining the location of the adductor canal using ultrasound ncbi. Femoral triangle and adductor canal flashcards quizlet. It is 15cm long, extending from the apex of the femoral triangle to the adductor hiatus of the adductor magnus. Not sure if any of you are doing continuous adductor canal blocks for tkas. Adductor canal block may be a misnomer for an approach that is. Sail this should be easy to remember because the femoral triangle is shaped like a sail. It has caught my interest and i am debating running a side to side comparison. This block is otherwise known as a transsartorial approach to the saphenous nerve. Proximal adductor canal just under the sartorius musce.
Adductor canal block versus femoral nerve block for total knee arthroplasty. Adductor canal compression syndrome a forgotten disease. Ultrasound guided adductor canal block versus femoral nerve block for anterior cruciate ligament reconstruction in pediatrics the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Recently, the adductor canal block acb has been described and used frequently as postoperative analgesia after total knee arthroplasty,9,10,11,12 where it was shown to provide a reliable postoperative pain control with less quadriceps weakness compared with that of using the fnb. This preserves much of the quadriceps strength making early ambulation and rehab safer. Aug 08, 2018 adductor canal is 15cm long and stretches from the apex of the femoral triangle, above, to the tendinous opening in the adductor magnus, below.
Preoperative adductor and femoral nerve blocks have been used to decrease postoperative pain for total knee arthroplasty. Continuous ultrasoundguided adductor canal block for total. Liposomal bupivacaine vs adductor canal block in total. Posteriorly the border of the canal is the adductor compartment, namely the adductor magnus. The apex of the femoral triangle was identified ultrasonographically as the intersection of the medial borders of the sartorius and adductor longus muscles. Ultrasoundguided saphenous adductor canal block nysora.
Adductor canal compression syndrome jama surgery jama network. Inferiorly, the apex of the triangle is where the medial borders of sartorius and adductor longus meet. Resources american society of regional anesthesia and. There is more evidence now that a proximal adductor canal block gets the nerve to the vastus medialus and the saphenous. Surgical approach chapter 36 and management of tumors of. The adductor canal hunters canal is approximately 15 cm long, extending from the apex of the femoral triangle to the adductor hiatus in the adductor magnus muscle. The adductor longus makes up the floor of the canal. Conclusions adductor canal blockade with bupivacaine 0. Effects of adductorcanalblockade on pain and ambulation. The adductor canal is an aponeurotic tunnel in the middle third of the thigh, extending from the apex of the femoral triangle to the opening of the adductor magnus tendon, known as the adductor hiatus. It commences at the inferior end of the femoral triangle and terminates at the adductor hiatus. Impairment of sciatic nerve function during adductor canal. An anesthesiologist will perform this procedure, and most patients can receive a prolonged nerve block if a catheter is placed for up to 34 days for continued pain relief.
Femoral artery and its branches it emerges from the base of the femoral triangle at the midinguinal point midpoint between the anterior superior iliac spine and the pubic symphysis of the pelvic bone and exits through the apex of the triangle into the adductor canal. An adductor canal nerve block is a specific type of regional anesthesia performed for procedures on the lower extremities, most commonly for total knee replacement surgery. We hypothesized that the adductorcanalblockade may reduce morphine consumption primary endpoint, improve pain relief, enhance early ambulation ability, and reduce side effects secondary endpoints after tka compared with. Continuous adductor canal block for tka student doctor network.
It is the result of arterial compression by an abnormal musculotendinous band arising from the adductor magnus muscle and lying adjacent and superior to the adductor tendon. The roof of the canal is the sartorius muscle, which lies anterior and medial to the canal. Adductor canal compression syndrome jama surgery jama. Femoral triangle contents mnemonic radiology reference. The adductor canal block aims to block the saphenous nerve, a terminal branch of the femoral nerve, at the midthigh. Trough shaped intermuscular tunnel lies in the medial aspect of the distal thigh the adductor canal 4.
A mnemonic for the boundaries of the femoral triangle is. So far i have performed about 200 adductor canal blocks with bupivacaine preoperatively and the ortho dudes inject 1 bottle of exparel into the knee. In recent years, the focus of acute pain management strategies following total knee arthroplasty has shifted from femoral nerve block to adductor canal block. Adductor canal blockade is a new technique for pain relief after knee surgery. Adductor canal blockade is an effective pain management adjunct for patients undergoing tka. Morphology of saphenous nerve in cadavers synapse koreamed. Femoral triangle the femoral triangle is located on the anterior side of the thigh, just below the inguinal ligament.
Nov 11, 2014 anatomy front of the thigh adductor canal part 7 dr. It is an intermuscular cleft situated on the medial aspect of the middle third of. Jan 12, 2017 femoral nerve blocks fnb can provide effective pain relief but result in quadriceps weakness with increased risk of falls following total knee arthroplasty tka. Fyi, i have also performed a few adductor canal blocks with exparel followed by the ortho dudes using one bottle of exparel for local infiltration. Although several studies have compared the clinical efficacy of an adductor canal block acb to that of a femoral nerve block fnb for analgesia after total knee arthroplasty tka, disputes mainly exist in the recovery of quadriceps strength and mobilization ability between the two methods. Adductor canal definition of adductor canal by the free.
Comparison of adductor canal and femoral nerve blocks in. The adductor canal the adductor canal hu ters ca al, subsartorial canal is a narrow conical tunnel located in the thigh. Eighty subjects presenting for primary unilateral total knee arthroplasty were randomized to receive either a continuous ultrasoundguided adductor canal block with 0. There are a number of studies supporting the adductor canal nerve block as a viable alternative for postoperative analgesia after total knee arthroplasty.
Adductor canal gives passage to the femoral vessels from femoral triangle to the popliteal fossa. Continuous ultrasoundguided adductor canal block for. I cant recall anyone every having and adductor canal block instead, but its something you. Gross 2 exam 1 questions and study guide quizlet flashcards. Femoral nerve blocks fnb can provide effective pain relief but result in quadriceps weakness with increased risk of falls following total knee arthroplasty tka. The hunters canal subsartorial, adductor canal is an aponeurotic tunnel in the. For this block, relatively high volumes of dilute local anesthetic are injected deep to the sartorius muscle in the thigh. It is a great way to give you a head start on recovery with virtually no pain for the first 24 hours.
The anatomical snuffbox borders contents teachmeanatomy. Mar 14, 2017 the adductors are a group of muscles, as the name suggests, that primarily function to adduct the femur at the hip joint. The saphenous nerve descends along the medial side of the. Thigh and femoral triangle thigh and femoral triangle study guide by rachelmaccann includes 41 questions covering vocabulary, terms and more. Femoral triangle boundaries mnemonic radiology reference. The major advantage of the adductor canal catheter is that it is presumably entirely sensory. Adductor canal syndrome is an unusual cause of acute arterial occlusion in younger men. Femoral nerve block versus adductor canal block for. The adductor canal also known as the hunter canal or subsartorial canal is a muscular tunnel in the thigh. Alcocks canal a tunnel formed by a splitting of the obturator fascia, which.
The inguinal canal boundaries contents teachmeanatomy. Bhanu prakash usmle, fmge and neet pg 68,924 views. The proximal end of the adductor canal was identified where the medial border of the. Starts at the apex of the femoral triangle the adductor canal 5. More comprehensive studies are required to examine overall patient satisfaction including a variety of questions asking for the quality of pain, stress, and anxiety and. In the absence of data regarding the distribution of local anaesthetic within the adductor canal in the presence of a thigh tourniquet, successful distal filling of the adductor canal using 20mls of local anaesthetic recommended by the authors, may be best achieved when the surgery is complete and tourniquet deflated.
The saphenous nerve is the largest cutaneous branch of the femoral nerve. Jeanlouis horn, md professor, chief, division of regional anesthesia department of anesthesiology, perioperative and pain medicine adductor canal block vs. What are the adductor muscles attachments and actions. It is superior and parallel to the inguinal ligament.
Fellows and residents have roundtheclock access to the library. Containing over 700 vibrant, fullcolour images, teachmeanatomy is a comprehensive anatomy encyclopedia presented in a visuallyappealing, easytoread format. Dec 29, 2014 we report a case of a 55yearold male who was diagnosed with the adductor canal compression syndrome a rarely described nontraumatic disorder of the lower limb resulting from the external. Aug 11, 2016 liposomal bupivacaine vs adductor canal block in total knee arthroplasty the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. American society of regional anesthesia and pain medicine advancing the science and practice of regional anesthesiology and pain medicine to improve patient outcomes through research, education, and advocacy 3 penn center west, suite 224 pittsburgh, pa 15276 855. Prevalence of saphenous nerve injury after adductorcanal. The adductor canal block acb is being increasingly used for postoperative analgesia in knee surgery since its first description. The adductor canal is a narrow fascial tunnel in the thigh, providing an intramuscular passage. The anatomical snuffbox also known as the radial fossa, is a triangular depression found on the lateral aspect of the dorsum of the hand. Since its founding in 1935, the kim barrett memorial library at surgery hss is a vital inhouse resource for hss staff. The femoral triangle is a region found at the medial aspect of the upper thigh the floor of the triangle is gutter shaped 4. Its contents are the femoral artery, the femoral vein, the nerve to vastus medialis and the saphenous nerve.
However, the analgesic effectiveness of the acb after aclr. Liposomal bupivacaine vs adductor canal block in total knee arthroplasty. Ultrasoundguided infrapatellar nerve block in human volunteers. Quizlet flashcards, activities and games help you improve your grades. Though femoral hernias are rare, their passage through the inflexible femoral ring puts them at particular risk of strangulation, giving them surgical priority. Comparison of adductor canal and femoral nerve blocks in primary tka philip fontenot, james kyle, matthew delarosa, vinod dasa louisiana state health sciences center new orleans background. Mnemonics to recall the order of the femoral vessels and nerve as they emerge from beneath the inguinal ligament into the femoral triangle are.