David Burckett-St Laurant1, Philip Peng, Laura Girón Arango, Ahtsham U Niazi, Vincent W S Chan, Anne Agur, Anahi Perlas. 1. From the *Department of Anaesthesia, University Hospital of Wales, Cardiff, United Kingdom; †Department of Anesthesia, University of Toronto; ‡Department of Anesthesia, University Health Network, Toronto, Ontario, Canada; §Department of Anesthesia, Universidad CES, Medellin, Colombia; and ∥Department of Anatomy, University of Toronto, Toronto, Ontario, Canada.
Abstract
BACKGROUND AND OBJECTIVES: Adductor canal block contributes to analgesia after total knee arthroplasty. However, controversy exists regarding the target nerves and the ideal site of local anesthetic administration. The aim of this cadaveric study was to identify the trajectory of all nerves that course in the adductor canal from their origin to their termination and describe their relative contributions to the innervation of the knee joint. METHODS: After research ethics board approval, 20 cadaveric lower limbs were examined using standard dissection technique. Branches of both the femoral and obturator nerves were explored along the adductor canal and all branches followed to their termination. RESULTS: Both the saphenous nerve (SN) and the nerve to vastus medialis (NVM) were consistently identified, whereas branches of the anterior obturator nerve were inconsistently present. The NVM contributed significantly to the innervation of the knee capsule, through intramuscular, extramuscular, and deep genicular nerves. The SN had a relatively more modest contribution through superficial infrapatellar and posterior branches as well as contributing to the origin of the deep genicular nerves. CONCLUSIONS: The results suggest that both the SN and NVM contribute to the innervation of the anteromedial knee joint and are therefore important targets of adductor canal block. Given the site of exit of both nerves in the distal third of the adductor canal, the midportion of the adductor canal is suggested as an optimal site of local anesthetic administration to block both target nerves while minimizing the possibility of proximal spread to the femoral triangle.
BACKGROUND AND OBJECTIVES: Adductor canal block contributes to analgesia after total knee arthroplasty. However, controversy exists regarding the target nerves and the ideal site of local anesthetic administration. The aim of this cadaveric study was to identify the trajectory of all nerves that course in the adductor canal from their origin to their termination and describe their relative contributions to the innervation of the knee joint. METHODS: After research ethics board approval, 20 cadaveric lower limbs were examined using standard dissection technique. Branches of both the femoral and obturator nerves were explored along the adductor canal and all branches followed to their termination. RESULTS: Both the saphenous nerve (SN) and the nerve to vastus medialis (NVM) were consistently identified, whereas branches of the anterior obturator nerve were inconsistently present. The NVM contributed significantly to the innervation of the knee capsule, through intramuscular, extramuscular, and deep genicular nerves. The SN had a relatively more modest contribution through superficial infrapatellar and posterior branches as well as contributing to the origin of the deep genicular nerves. CONCLUSIONS: The results suggest that both the SN and NVM contribute to the innervation of the anteromedial knee joint and are therefore important targets of adductor canal block. Given the site of exit of both nerves in the distal third of the adductor canal, the midportion of the adductor canal is suggested as an optimal site of local anesthetic administration to block both target nerves while minimizing the possibility of proximal spread to the femoral triangle.