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Am Fam Physician 2020 Jun;101(11):669-679

Uniformed Services University of the Health Sciences, Bethesda, MD, USA.

Family physicians use anesthesia to provide diagnostic and procedural analgesia for conditions such as neuropathies, fracture reduction, foreign body removals, and complex wound management. Local infiltration of anesthetics is commonly used in this setting because of the ease of use, safety, and effectiveness of the procedure. Nerve blocks are a specific regional anesthesia technique that blocks nerve function distal to the injection site. Read More

Arthroscopy 2020 May 23. Epub 2020 May 23.

Valiant Clinic/Houston Methodist Group, Dubai, United Arab Emirates; School of Medicine, University of Pretoria, South Africa. Electronic address:

Femoral nerve block (FNB) is commonly used for pain control after knee surgery and helps to reduce the need for opioids in the early postoperative period . The potential disadvantage is blockage of the motor branch of the femoral nerve resulting in quadriceps weakness and reduced strength by up to 50%. Adductor canal nerve block (ACB) is a possible alternative resulting in less muscle weakness. Read More

Am J Sports Med 2020 Jun 28;48(7):1689-1695. Epub 2020 Apr 28.

Kinesiology Department, University of Virginia, Charlottesville, Virginia, USA.

Background: Patients often have quadriceps or hamstring weakness after anterior cruciate ligament reconstruction (ACLR), despite postoperative physical therapy regimens; however, little evidence exists connecting nerve blocks and ACLR outcomes.

Purpose: To compare muscle strength at return to play in patients who received a nerve block with ACLR and determine whether a specific block type affected subjective knee function.

Study Design: Cohort study; Level of evidence, 3. Read More

J Arthroplasty 2020 Jun 12;35(6S):S168-S172. Epub 2020 Mar 12.

Institute of Orthopaedics "Carlos E. Ottolenghi", Italian Hospital of Buenos Aires, Buenos Aires, Argentina.

Background: Numerous strategies exist for pain management after total knee arthroplasty (TKA), with a fast recovery and early ambulation required for full function. Currently, there is no universal standard of care to facilitate this management. We assessed pain management safety and efficacy after TKA, using intra-articular infiltration associated with peripheral saphenous nerve block (SNB) vs intra-articular infiltration alone. Read More

J Arthroplasty 2020 May 22;35(5):1233-1238. Epub 2020 Jan 22.

Department of Orthopaedic Surgery, Duke University, Durham, NC; Department of Orthopaedic Surgery, Durham VA Medical Center, Durham, NC.

Background: Periarticular injection or anesthesiologist-performed adductor canal block are commonly used for pain management after total knee arthroplasty. A surgeon-performed, intra-articular saphenous nerve block has been recently described. There is insufficient data comparing the efficacy and safety of these methods. Read More

Saudi J Anaesth 2020 Jan-Mar;14(1):85-90. Epub 2020 Jan 6.

Anaesthesiologist, Military Hospital Kirkee, Pune, Maharashtra, India.

Post-operative knee pain management has become a challenge to provide early relief and pain-free postoperative care to the patient. The major objectives of post-operative analgesic treatment are to reduce opioid requirements, post-operative pain, and adverse events related to opioid intake. This narrative review aimed to document post-operative analgesia techniques after total knee arthroplasty (TKA). Read More

Br J Anaesth 2020 Jan 21. Epub 2020 Jan 21.

Iowa City, IA, USA.

Br J Anaesth 2020 03 20;124(3):308-313. Epub 2020 Jan 20.

Department of Anaesthesiology, Intensive Care, Palliative and Pain Medicine, BG University Hospital Bergmannsheil Bochum, Bochum, Germany; Department of Anaesthesiology, Intensive Care and Pain Medicine, Hessing Foundation, Augsburg, Germany.

Background: Incomplete peripheral nerve blocks distal to the popliteal region are commonly considered a sciatic and femoral/saphenous nerve block failure. The existence of a much more distal innervation area of the posterior femoral cutaneous nerve (PFCN) as described has not been assumed yet. We therefore investigated the distal termination of the PFCN in the lower leg. Read More

Ann Vasc Dis 2019 Dec;12(4):551-554

Department of Vascular Surgery, Asahikawa Medical University, Asahikawa, Hokkaido, Japan.

A 51-year-old man with severe comorbidities required redo revascularization due to left chronic limb-threatening ischemia caused by a previous vein graft occlusion. The saphenous veins were not available due to previous surgeries. Femoro-posterior tibial artery bypass surgery was successfully performed using the basilic-cephalic loop vein under peripheral nerve blockades. Read More

Reg Anesth Pain Med 2019 Dec 25. Epub 2019 Dec 25.

Division of Anatomy, Department of Surgery, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada.

Background And Objectives: Quadriceps sparing adductor canal block has emerged as a viable intervention to manage pain after total knee arthroplasty. Recent studies have defined ultrasound (US) landmarks to localize the proximal and distal adductor canal. US-guided proximal adductor canal injection has not been investigated using these sonographic landmarks. Read More

Orthopedics 2020 Jan 26;43(1):e47-e53. Epub 2019 Nov 26.

This study compared the postoperative analgesic efficacy of liposomal bupivacaine as a single-administration adductor canal block (ACB) vs periarticular injection (PAI) for pain control after total knee arthroplasty (TKA). From May 2016 to June 2017, a total of 70 unilateral TKA patients were randomized into 2 groups: PAI (extended-release bupivacaine 266 mg [20-mL vial] with 20 mL of 0.5% bupivacaine hydrochloride and normal saline to a total volume of 120 mL) and ACB (subsartorial saphenous nerve using extended-release bupivacaine 266 mg [20-mL vial]). Read More

Anat Cell Biol 2019 Sep 26;52(3):262-268. Epub 2019 Sep 26.

Department of Anatomy, Medical University of the Americas, Charlestown, Saint Kitts and Nevis, West Indies.

The knowledge about detailed morphology and relation of saphenous nerve is important to obtain successful saphenous nerve regional blocks to achieve pre- and post-operative anesthesia and analgesia, nerve entrapment treatments and to avoid damage of saphenous nerve during knee and ankle surgeries. The literature describing detailed morphology of saphenous nerve is very limited. We dissected 42 formalin fixed well embalmed cadaveric lower limbs to explore detailed anatomy, relation and mode of termination of saphenous nerve and measured the distances from the nearby palpable bony landmarks. Read More

Anaesthesia 2019 11 29;74(11):1397-1405. Epub 2019 Aug 29.

Department of Anaesthesia and Intensive Care Medicine, Copenhagen University Hospital, Gentofte Hospital, Gentofte, Denmark.

We performed a randomised, blinded, controlled study with adult patients scheduled for primary total knee arthroplasty under spinal anaesthesia. The aim was to investigate the analgesic effects of adductor canal block using catheter-based repeated boluses, either through a new suture-method catheter or a standard perineural catheter, compared with a single-injection technique. All patients received an adductor canal block after surgery with an initial bolus of 20 ml ropivacaine 0. Read More

Reg Anesth Pain Med 2020 03 26;45(3):245-246. Epub 2019 Aug 26.

Surgery (Division of Anatomy), University of Toronto, Toronto, Ontario, Canada.

Reg Anesth Pain Med 2019 Aug 26. Epub 2019 Aug 26.

Anaesthetics, Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK.

Surg Radiol Anat 2019 Dec 23;41(12):1461-1471. Epub 2019 Jul 23.

Neuro-Musculo-Skeletal Pole (NMSK), Experimental and Clinical Research Institute (IREC), Université Catholique de Louvain (UCLouvain), Tour Pasteur, Avenue Mounier 53, 1200, Brussels, Belgium.

Background: Despite their emerging therapeutic relevance, there are many discrepancies in anatomical description and terminology of the articular nerves supplying the human knee capsule. This cadaveric study aimed to determine their origin, trajectory, relationship and landmarks for therapeutic purpose.

Methods: We dissected 21 lower limbs from 21 cadavers, to investigate the anatomical distribution of all the articular nerves supplying the knee joint capsule. Read More

Foot Ankle Int 2019 Oct 23;40(10):1209-1213. Epub 2019 Jul 23.

Department of Orthopedic Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.

Background: Dorsal pain from osteoarthritic midfoot joints is thought to be relayed by branches of the medial and lateral plantar, sural, saphenous, and deep peroneal nerves (DPN). However, there is no consensus on the actual number or pathways of the nervous branches for midfoot joint capsular innervation. This study examined the DPN's terminal branches at the midfoot joint capsules through anatomic dissection and confirmation of their significance in a clinical case series of patients with midfoot pain relief after DPN block. Read More

Cureus 2019 May 15;11(5):e4668. Epub 2019 May 15.

Pain Department and Interdisciplinary Pain Management Center, Tripler Army Medical Center, Kaneohe, USA.

The infrapatellar branch of the saphenous is becoming a common therapeutic target for the diagnosis and treatment of anterior knee pain. It is a nerve commonly injured during knee surgeries, resulting in neuroma formation and chronic neuropathic pain states, and can also transmit nociceptive input in patients with non-surgical anterior knee pain of multiple etiologies. After diagnosing infrapatellar saphenous neuralgia, the nerve is safely ablated using radiofrequency ablation, neurolytic solutions, and, most recently, cryoablation using the handheld iovera® cryoablation system (Myoscience, Inc. Read More

Medicine (Baltimore) 2019 Jul;98(28):e16450

Department of Orthopedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York, New York.

Persistent postsurgical pain (PPP) is defined as the discomfort that lasts >3 months postoperatively. The primary aim of this retrospective study was to estimate the risk of developing moderate-to-severe PPP after primary total knee arthroplasty (TKA). The secondary goal was to explore potential predictors of this outcome. Read More

Eur J Vasc Endovasc Surg 2019 08 1;58(2):206-213. Epub 2019 Jul 1.

Department of Vascular Surgery, Asahikawa Medical University, Asahikawa, Japan. Electronic address:

Objectives: Surgical revascularisation to accomplish limb salvage remains preferable in some patients with chronic limb threatening ischaemia (CLTI). The aim of this study was to evaluate the effectiveness and safety of ultrasound guided lower extremity nerve blockade (UGNB) in infragenicular bypass surgery (IGBS).

Methods: This was a single centre, retrospective clinical study. Read More

Best Pract Res Clin Anaesthesiol 2019 Mar 7;33(1):79-93. Epub 2019 May 7.

Department of Anaesthesiology, University Hospitals of the KU Leuven, Herestraat 49, 3000, Leuven, Belgium.

Following forefoot surgery, compared to the traditional multimodal approach, regional anesthesia and analgesia provides high quality pain relief, decreases opioids consumption and leads to very high satisfaction scores. Traditional regional techniques relied either on wound infiltration, landmark technique ankle blocks or popliteal sciatic nerve block. Numerous anatomic variations of the different nerves might lead to failure following a blind technique. Read More

Anesth Essays Res 2019 Apr-Jun;13(2):284-286

Department of Anaesthesia, Sri Ramachandra Medical College, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India.

Background And Objectives: Adductor canal block is a regional anesthetic block procedure commonly employed for knee surgeries. This study aims at locating the adductor canal precisely which will be of great use for the surgeons operating on knee.

Materials And Methods: Forty cadaveric lower limbs fixed with formalin were utilized for the study. Read More

Rom J Anaesth Intensive Care 2019 Apr;26(1):9-15

Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, USA.

Background: The classic adductor canal block (ACB) is a regional technique that aims to introduce local anesthetic to the saphenous nerve as it traverses the adductor canal. It offers the benefit of preserved quadriceps strength, and is ideal for rehabilitation. Proximal ACB (PACB) allows the operator to place the block away from the surgical site, permitting preoperative placement. Read More

Br J Pain 2019 May 30;13(2):91-98. Epub 2018 Aug 30.

Department of Orthopaedics, Government Medical College and Hospital, Chandigarh, India.

Introduction: Local anaesthetic (LA) with highly selective alpha-2 agonist dexmedetomidine has not been evaluated in adductor canal block (ACB) for arthroscopic anterior cruciate ligament (ACL) reconstruction surgeries. The study evaluates postoperative analgesic effect of ropivacaine with adjuvant dexmedetomidine following postoperative ultrasound-guided ACB.

Methods: 105 randomized subjects received ultrasound-guided ACB using 15 mL of 0. Read More

Indian J Orthop 2019 Jan-Feb;53(1):208-212

1st Department of Orthopaedics, School of Medicine, National and Kapodistrian University of Athens, "Attikon" Hospital, Athens, Greece.

Saphenous neuralgia is characterized by persistent neuropathic pain at the distribution of the saphenous nerve. Injury to the saphenous nerve, and specifically to its infrapatellar branch of the saphenous nerve has been implicated as a cause of medial knee pain after orthopedic knee surgery or trauma. We present two cases of saphenous neuralgia, one after total knee arthroplasty and the other after anterior cruciate ligament reconstruction, that were adequately treated with ultrasound-guided saphenous nerve blocks distal to the adductor canal. Read More

J Clin Anesth 2019 Nov 6;57:22-23. Epub 2019 Mar 6.

Department of Anesthesiology, Shanghai Jiaotong University Affiliated Sixth People's Hospital, China. Electronic address:

J Clin Anesth 2019 05 13;54:160-161. Epub 2018 Dec 13.

Department of Anesthesiology, Perioperative, and Pain Medicine, Lucile Packard Children's Hospital Stanford, Palo Alto, CA, United States. Electronic address:

Acta Anaesthesiol Scand 2019 04 6;63(4):523-530. Epub 2018 Dec 6.

Department of Anaesthesia and Intensive Care Medicine, Copenhagen University Hospital, Nordsjaellands Hospital, Hillerød, Denmark.

Background: We performed a randomised blinded pilot study in 16 healthy volunteers to assess whether placing a suture-method catheter in the adductor canal is feasible with two different insertion techniques.

Methods: Each volunteer had a suture-method catheter placed approximately halfway between the superior anterior iliac spine and base of the patella in both legs. Catheters were placed using a parallel technique in one leg and a perpendicular technique in the other leg, according to randomisation. Read More

Acta Anaesthesiol Scand 2019 03 8;63(3):396-402. Epub 2018 Nov 8.

Department of Anaesthesiology, Herlev and Gentofte University Hospital, Herlev, Denmark.

Background: Peripheral nerve blocks (PNB) are increasingly used for anaesthesia and postoperative pain control in acute orthopaedic limb surgery but rebound pain upon cessation of PNBs may challenge the benefits on the pain profile. We aimed to explore the pain profile following acute ankle fracture surgery under PNB anaesthesia and investigate if rebound pain could pose a clinical problem.

Methods: Exploratory, observational study of adults scheduled for acute primary internal fixation of an ankle fracture under ultrasound-guided popliteal sciatic and saphenous ropivacaine block anaesthesia. Read More

Zhongguo Gu Shang 2018 Oct;31(10):907-911

Department of Anesthesiology, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing 100102, China.

Objective: To explore clinical effects of ultrasound guided popliteal sciatic nerve combined saphenous nerve block in patients with anterior foot orthopedics.

Methods: From January 2017 to October 2017, 60 hallux valgus patients with metatarsophalangeal joint dislocation were randomly divided into experimental and control group according to random number table. Thirty patients in experimental group were treated by ultrasound guided popliteal sciatic nerve combined saphenous nerve block, including 13 males and 17 females, aged 31 to 76 years old with an average of (59. Read More

Orthop J Sports Med 2018 Oct 10;6(10):2325967118800948. Epub 2018 Oct 10.

Investigation performed at Unisports Sports Medicine, Auckland, New Zealand.

Background: For reconstruction of the anterior cruciate ligament (ACL) with hamstring autograft, perioperative analgesia can be achieved with multimodal analgesia and intra-articular local anesthesia infiltration with or without additional regional blocks. Saphenous nerve block (SNB) via the adductor canal is commonly used in our practice, but its benefit has not been well established in the literature.

Purpose: To assess the efficacy of SNB in ACL reconstruction with hamstring autograft. Read More

Surg Radiol Anat 2018 Nov 23;40(11):1267-1274. Epub 2018 Aug 23.

Department of Anatomy, Ankara University Faculty of Medicine, Ankara, Turkey.

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. Read More

J Int Med Res 2018 Oct 20;46(10):4207-4213. Epub 2018 Aug 20.

1 Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.

Objective This study aimed to identify the median effective volume of ropivacaine 0.5% for ultrasound-guided adductor canal block (ACB). Methods Thirty-two patients received ultrasound-guided ACB for knee arthroscopic meniscectomy. Read More

Vet Anaesth Analg 2018 Jul 29;45(4):566-574. Epub 2018 Mar 29.

Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA.

Objective: To evaluate an ultrasound-guided technique for adductor canal (AC) block by describing the distribution of methylene blue around the AC, popliteal fossa, saphenous, tibial and common fibular nerves in dog cadavers.

Study Design: Prospective experimental trial.

Animals: Ten mixed breed canine cadavers weighing 28. Read More

Curr Sports Med Rep 2018 May;17(5):146-147

Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL.

Foot Ankle Int 2018 05;39(5):638

Foot Ankle Int 2018 05;39(5):637

Reg Anesth Pain Med 2018 Jul;43(5):474-479

Department of Anesthesiology and Intensive Care Medicine, Kolding Hospital, Kolding, Denmark.

Background And Objectives: Major ankle surgery causes intense postoperative pain, and whereas the importance of a sciatic nerve block is well established, the clinical significance of a supplemental saphenous nerve block has never been determined in a prospective, randomized, double-blind, placebo-controlled trial. We hypothesized that a saphenous nerve block reduces the proportion of patients experiencing significant clinical pain after major ankle surgery.

Methods: Eighteen patients were enrolled and received a popliteal sciatic nerve block. Read More

Clin Orthop Relat Res 2018 01;476(1):37-39

E. Thienpont Saint Luc University Hospital, Department of Orthopaedic Surgery, Woluwe-Saint-Lambert, Brussels, Belgium.

Clin Orthop Relat Res 2018 01;476(1):30-36

J. J. Kavolus, D. E. Attarian, P. F. Lachiewicz Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA D. Sia, H. G. Potter, Department of Radiology and Imaging, MRI Research, Hospital for Special Surgery, New York, NY, USA.

Background: Surgeon-performed periarticular injections and anesthesiologist-performed femoral nerve or adductor canal blocks with local anesthetic are in common use as part of multimodal pain management regimens for patients undergoing TKA. However, femoral nerve blocks risk causing quadriceps weakness and falls, and anesthesiologist-performed adductor canal blocks are costly in time and resources and may be unreliable. We investigated the feasibility of a surgeon-performed saphenous nerve ("adductor canal") block from within the knee at the time of TKA. Read More

Clin Case Rep 2018 02 4;6(2):454-455. Epub 2018 Jan 4.

University of Medicine and Pharmacy "Iuliu Hațieganu" Cluj Napoca Cluj Napoca Romania.

Ultrasound-guided saphenous nerve block above the knee may be a valuable diagnosis tool in patient presenting chronic pain of the calf. Read More

Acta Anaesthesiol Scand 2018 Apr 20;62(4):548-557. Epub 2017 Dec 20.

Department of Anaesthesiology and Intensive Care Medicine, Aarhus University Hospital, Aarhus, Denmark.

Background: Major hindfoot and ankle surgery is associated with severe postoperative pain, which is effectively alleviated by combined sciatic and saphenous nerve blockade. Local anaesthetics with added dexamethasone consistently prolongs the duration of pain relief compared to local anaesthetics alone. However, whether the extended duration of pain relief is due to an effect on duration of sensorimotor block per se vs. Read More

Foot Ankle Int 2018 03 18;39(3):332-337. Epub 2017 Dec 18.

2 Rothman Institute Department of Orthopaedics, Thomas Jefferson University Hospital, Philadelphia, PA, USA.

Background: The increasing scope and complexity of foot and ankle procedures performed in an outpatient setting require more intensive perioperative analgesia. Regional anesthesia (popliteal and saphenous nerve blocks) has been proven to provide satisfactory pain management, decreased postoperative opioid use, and earlier patient discharge. This can be further augmented with the placement of a continuous-flow catheter, typically inserted into the popliteal nerve region. Read More

Reg Anesth Pain Med 2018 Jan;43(1):43-49

Background And Objectives: Obstructive sleep apnea is associated with increased complication rates postoperatively. Current literature does not provide adequate guidance on management of these patients. This study used the STOP-Bang questionnaire to diagnose patients with possible obstructive sleep apnea (score ≥3). Read More

J Orthop Surg Res 2017 Dec 4;12(1):188. Epub 2017 Dec 4.

Department of Orthopaedic Surgery, National University Health Systems (NUHS), 1E Kent Ridge Road, NUHS Tower Block Level 11, Singapore, 119228, Singapore.

Background: Bucket-handle meniscus tears (BHMT) are often displaced and unstable. The inside-out technique of repairing such tears is currently the gold standard. All-inside repair with meniscal fixators is getting increasingly popular. Read More

Reg Anesth Pain Med 2017 Nov/Dec;42(6):725-730

From the *Elective Surgery Centre, Silkeborg Regional Hospital, Silkeborg, Denmark; †Division of Clinical and Functional Anatomy, Medical University of Innsbruck, Innsbruck, Austria; and ‡Department of Anesthesiology and Intensive Care Medicine, Zealand University Hospital, University of Copenhagen, Copenhagen; and §Department of Anesthesiology, Aarhus University Hospital, Aarhus, Denmark.

Background And Objectives: The popliteal nerve plexus contributes to afferent knee-pain conduction. It is mainly formed by genicular branches from the posterior obturator and the tibial nerves, innervating the intra-articular and posterior knee region. A subinguinal obturator nerve block alleviates pain after total knee arthroplasty. Read More