Outpatient Surgery Magazine - Subscribers

OR Excellence Awards 2015 - September 2015 - Outpatient Surgery Magazine

Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.

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1 4 9 S E P T E M B E R 2 0 1 5 | O U T P A T I E N T S U R G E R Y . N E T to the quadriceps weakness and atrophy that can result from a femoral nerve injury. A recent study (osmag.net/nJU5nT) by Stanford's Christopher Webb, MD, and Edward R. Mariano, MD, concludes that "when not contraindicated, intraoperative neuraxial anesthesia combined with a continuous adductor canal block and a multimodal medication regimen for post- operative pain control is the best analgesic protocol for knee arthro- plasty." The block is performed with an injection of local anesthetic at the mid-thigh. The anatomical boundaries of the adductor canal are the sartorius muscle medially, the vastus medialis anterolaterally and the adductor magnus (and femoral artery and vein) posteriorly. The tech- nique would be very challenging to perform solely with landmarks, but with high-frequency ultrasound and a little practice, you can easi- ly visualize the muscles, vessel landmarks, needle and injected local anesthetic. The canal contains several nerve branches that provide sensory innervation to the knee, including the saphenous nerve, the nerve to vastus medialis and the posterior branch of the obturator nerve. The saphenous nerve is probably the most important, but the total analge- sia is likely due to the cumulative effect of blocking all 3 branches. That's why it's not simply called a "saphenous nerve block" when it's used for knee analgesia. How it's done Here are the steps I use to place non-stimulating adductor canal catheters pre-operatively, using a catheter-through-needle approach See How It's Done See Dr. Winchester's step-by-step video on how to place an adductor canal block at bit.ly/blockjocksadductorcanal.

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