Why all this talk about an adductor canal block (ACB)?
For years, femoral nerve blocks (FNB) have been the gold standard for pain control in more invasive knee/lower leg surgeries (total knees, ACLs, etc.). More recently, adductor canal blocks have been gaining in popularity over femoral nerve blocks because there seems to be less motor blockade from ACB than FNB. This is important because it decreases fall risk and allows earlier patient ambulation while also providing adequate analgesia.
- Regional Anesthesia & Pain Medicine – Aug 2013. Kwofie et al. The effects of ultrasound-guided ACB vs FNB on quadriceps strength and fall risk.
- Regional Anesthesia & Pain Medicine – Nov 2013. Jaeger et al. ACB vs FNB for analgesia after TKA: a randomized, double-blind study.
- Anesthesiology – Mar 2014. Kim et al. ACB vs FNB for TKA: a prospective, randomized, controlled trial.
- Clinical Orthopedics and Related Research – 1999. Mudumbai et al. Continuous ACBs are superior to continous FNBs in promoting early ambulation after TKAs.
- Clinical Anesthesiology – Feb 2014. O’Rourke. Study supports ACBs after TKAs.
- Clinical Trials. 2013-2015. ACBs in ACLs.
Anesthesiology Mar 2014. Kim et al. Adductor Canal Block versus Femoral Nerve Block for Total Knee Arthroplasty: A Prospective, Randomized, Controlled Trial.
From the ASA 2017:
Virtual Anatomy lab for regional:
- Femoral nb: fem art, Top of iliacus muscle, within fasc iliaca. Flat nerve. Want local anesthesia (LA) spread going under femoral artery (FA). Does hip joint capsule > Adductor CB (hip fractures, not THA). Catheters to POD3. Fascia iliaca more cranial than inguinal crease to get hip jt nerves. Do inplane to avoid bowel.
- Adductor Canal block: nerve sits on lateral side of FA. Want FA when dives under Sartorius muscle. Aim for bottom of FA to get under membrane. Block the Nerve to Vastus medialis nerve also (not effect motor). Nerve bt vastus med and sartorius. Looks like it’s in the membrane bt muscles. Want proximimal sartorius (pain and strength better)
How to place an adductor canal block