Proximal Versus Distal Continuous Adductor Canal Blocks: Does Varying Perineural Catheter Location Influence Analgesia? A Randomized, Subject-Masked, Controlled Clinical Trial

Anesthesia and Analgesia
Jacklynn F SztainBrian M Ilfeld

Abstract

A continuous adductor canal block provides analgesia after surgical procedures of the knee. Recent neuroanatomic descriptions of the thigh and knee led us to speculate that local anesthetic deposited in the distal thigh close to the adductor hiatus would provide superior analgesia compared to a more proximal catheter location. We therefore tested the hypothesis that during a continuous adductor canal nerve block, postoperative analgesia would be improved by placing the perineural catheter tip 2-3 cm cephalad to where the femoral artery descends posteriorly to the adductor hiatus (distal location) compared to a more proximal location at the midpoint between the anterior superior iliac spine and the superior border of the patella (proximal location). Preoperatively, subjects undergoing total knee arthroplasty received an ultrasound-guided perineural catheter inserted either in the proximal or distal location within the adductor canal in a randomized, subject-masked fashion. Subjects received a single injection of lidocaine 2% via the catheter preoperatively, followed by an infusion of ropivacaine 0.2% (8 mL/h basal, 4 mL bolus, 30 minutes lockout) for the study duration. After joint closure, the surgeon infiltrated the entire joi...Continue Reading

References

Nov 18, 2009·Regional Anesthesia and Pain Medicine·Baskar ManickamReva Ramlogan
Jun 22, 2013·Regional Anesthesia and Pain Medicine·David M MooreMichelle Duggan
Dec 21, 2013·Regional Anesthesia and Pain Medicine·Christian EgelerSimon Ford
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Dec 22, 2016·Regional Anesthesia and Pain Medicine·Wan Yi WongThomas Fichtner Bendtsen

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Citations

Nov 7, 2019·The Cochrane Database of Systematic Reviews·Alexander SchnabelChristine H Meyer-Frießem
Apr 10, 2020·The Clinical Journal of Pain·Chun-Guang WangQian Zhang
Jul 14, 2018·Current Opinion in Anaesthesiology·Sanjay K Sinha, Shivani Suter

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