S Kendir1, Bilge İpek Torun2, T Akkaya3, A Comert1, E Tuccar1, I Tekdemir1. 1. Department of Anatomy, Ankara University Faculty of Medicine, Ankara, Turkey. 2. Department of Anatomy, Ankara Yildirim Beyazit University Faculty of Medicine, Bilkent, 06600, Ankara, Turkey. bilgeipek@yahoo.com. 3. Department of Anesthesia and Pain Unit, University of Health Sciences Diskapi Yildirim Beyazit Research and Education Hospital, Ankara, Turkey.
Abstract
PURPOSE: The aim of this study is to re-define the anatomical structures which are important for blocking the sciatic nerve and the nerves within the adductor canal which innervate the knee joint through the same injection site. We also aimed to investigate the spread of the anesthetic toward the areas in which the mentioned nerves lie on cadavers. METHODS: This study was performed on 16 lower extremities of formaldehyde-embalmed eight adult cadavers. The anatomy of adductor canal, courses of the nerves within the canal and the relationships of the saphenous, medial femoral cutaneous, medial retinacular, posterior branch of the obturator and sciatic nerves with each other and with the fascial compartments were investigated. Transverse sections that crossed the superior border of vastoadductor membrane were taken to reach the sciatic nerve in the shortest way. Colored latex was injected to demonstrate the anesthetic blockage of the targeted nerves. The structures along the needle's way were investigated. RESULTS: The saphenous, medial femoral cutaneous and at its distal part posterior branch of the obturator nerve were colored with latex within the adductor canal. The nerve to vastus medialis (in other words, the medial retinacular nerve) lay beneath the fascia of vastus medialis and did not enter the adductor canal. There was a fascial plane which did not allow the passage of colored latex toward the sciatic nerve. To traverse this fascial structure, it was found out to be necessary to insert the needle perpendicular to both the vertical and transverse axes of the thigh and then advance it along 2/3 of diameter of the thigh. Thus, the colored latex was observed to fill the compartment where the sciatic nerve lay within. CONCLUSIONS: Blocking the sciatic nerve and the nerves within the adductor canal which innervate the knee joint through the same injection site seems anatomically possible without injuring any neurovascular structures.
PURPOSE: The aim of this study is to re-define the anatomical structures which are important for blocking the sciatic nerve and the nerves within the adductor canal which innervate the knee joint through the same injection site. We also aimed to investigate the spread of the anesthetic toward the areas in which the mentioned nerves lie on cadavers. METHODS: This study was performed on 16 lower extremities of formaldehyde-embalmed eight adult cadavers. The anatomy of adductor canal, courses of the nerves within the canal and the relationships of the saphenous, medial femoral cutaneous, medial retinacular, posterior branch of the obturator and sciatic nerves with each other and with the fascial compartments were investigated. Transverse sections that crossed the superior border of vastoadductor membrane were taken to reach the sciatic nerve in the shortest way. Colored latex was injected to demonstrate the anesthetic blockage of the targeted nerves. The structures along the needle's way were investigated. RESULTS: The saphenous, medial femoral cutaneous and at its distal part posterior branch of the obturator nerve were colored with latex within the adductor canal. The nerve to vastus medialis (in other words, the medial retinacular nerve) lay beneath the fascia of vastus medialis and did not enter the adductor canal. There was a fascial plane which did not allow the passage of colored latex toward the sciatic nerve. To traverse this fascial structure, it was found out to be necessary to insert the needle perpendicular to both the vertical and transverse axes of the thigh and then advance it along 2/3 of diameter of the thigh. Thus, the colored latex was observed to fill the compartment where the sciatic nerve lay within. CONCLUSIONS: Blocking the sciatic nerve and the nerves within the adductor canal which innervate the knee joint through the same injection site seems anatomically possible without injuring any neurovascular structures.
Authors: M Kwesi Kwofie; Uma D Shastri; Jeff C Gadsden; Sanjay K Sinha; Jonathan H Abrams; Daquan Xu; Emine A Salviz Journal: Reg Anesth Pain Med Date: 2013 Jul-Aug Impact factor: 6.288
Authors: Thomas Fichtner Bendtsen; Bernhard Moriggl; Vincent Chan; Erik Morre Pedersen; Jens Børglum Journal: Reg Anesth Pain Med Date: 2014 Sep-Oct Impact factor: 6.288
Authors: Brian M Ilfeld; Edward R Mariano; Paul J Girard; Vanessa J Loland; Scott R Meyer; John F Donovan; George A Pugh; Linda T Le; Daniel I Sessler; Jonathan J Shuster; Douglas W Theriaque; Scott T Ball Journal: Pain Date: 2010-06-22 Impact factor: 6.961
Authors: M T Jenstrup; P Jæger; J Lund; J S Fomsgaard; S Bache; O Mathiesen; T K Larsen; J B Dahl Journal: Acta Anaesthesiol Scand Date: 2012-01-04 Impact factor: 2.105