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Vet Anaesth Analg 2021 May 4;48(3):415-421. Epub 2021 Mar 4.

Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH, USA. Electronic address:

Objective: To compare the quality of postoperative analgesia and sedation after preoperative saphenous and sciatic nerve blockade, preoperative lumbosacral epidural injection and perioperative intravenous (IV) morphine, lidocaine and ketamine infusions in dogs undergoing stifle arthroscopy and tibial plateau leveling osteotomy (TPLO) under general anesthesia.

Study Design: Prospective, blinded, randomized, clinical comparison study.

Animals: A total of 45 dogs weighing 33. Read More

Br J Anaesth 2021 04 2;126(4):881-888. Epub 2021 Feb 2.

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

Background: Peripheral nerve blocks (PNBs) are increasingly popular in acute ankle fracture surgery but rebound pain may outweigh the benefits. The AnAnkle Trial was designed to assess the postoperative pain profile of PNB anaesthesia compared with spinal anaesthesia (SA).

Methods: The AnAnkle Trial was a randomised, two-centre, blinded outcome analysis trial. Read More

Anat Cell Biol 2021 Mar;54(1):124-127

Department of Anatomy, College of Medicine, The Catholic University of Korea, Seoul, Korea.

Understanding anatomic variations in neurovascular structure inside the femoral triangle is crucial for regional anesthesiologists performing femoral nerve block. During routine dissection of a cadaver, an ascending branch of the lateral circumflex femoral artery with an anomalous course passing through the femoral nerve, specifically the posterior division, was identified inside the femoral triangle on the left thigh. The novel variation identified in this study occurred in an early stage of prenatal development. Read More

J Pain Res 2021 13;14:53-59. Epub 2021 Jan 13.

Universidade Federal de São Paulo, Department of Anesthesia, São Paulo, Brazil.

Background: After knee surgery, analgesia should be effective for mobilization and discharge.

Aim Of The Study: The primary objective of this study was to achieve the lowest effective analgesic concentration (MEC50 and MEC90) of ropivacaine for saphenous nerve block in arthroscopic meniscectomy. The secondary objective was to determine whether the block causes muscle weakness in the postoperative period. Read More

Reg Anesth Pain Med 2021 Mar 11;46(3):228-232. Epub 2021 Jan 11.

Anesthesiology, Duke University Medical Center, Durham, North Carolina, USA

Introduction: Prolonged tourniquet inflation during surgery frequently leads to tourniquet hypertension (TH), which is thought to arise from compression of A-δ fibers leading to sympathetically mediated C fiber activation. In the lower extremity, C fibers and other sympathetic nerve fibers are carried along the femoral artery. We hypothesized that blockade of these fibers at the femoral artery would decrease the incidence of TH. Read More

Front Vet Sci 2020 27;7:538883. Epub 2020 Nov 27.

Department of Veterinary Medicine, Università degli Studi di Milano, Milan, Italy.

Little information is available regarding ultrasound-guided locoregional anesthesia in non-domestic species. Locoregional techniques have been shown to reduce intraoperative anesthetic requirements and provide postoperative pain relief. Decreasing dosage of general anesthetics allows more stable cardiopulmonary function during anesthesia and reduces the probability of side effects. Read More

J Foot Ankle Surg 2021 Jan-Feb;60(1):121-131. Epub 2020 Sep 3.

Orthopaedic Surgeon, Department of Orthopaedic Surgery, Foot and Ankle Service, Harvard Medical School, Massachusetts General Hospital and Newton-Wellesley Hospital, Boston, MA.

The purpose of this study was to perform a systematic review of the literature examining postoperative outcomes following single site and combined peripheral nerve blocks (PNBs), including (1) sciatic and femoral nerve, (2) popliteal and saphenous nerve, and (3) popliteal and ankle nerve, during elective foot and ankle surgery. We hypothesized that combination blocks would decrease postoperative narcotic consumption and afford more effective postoperative pain control as compared to general anesthesia, spinal anesthesia, or single site PNBs. A review of the literature was performed according to the PRISMA guidelines. Read More

BMC Anesthesiol 2020 10 9;20(1):260. Epub 2020 Oct 9.

Anesthesiology Department, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, and Peking Union Medical College, Shuaifuyuan 1#, Dongcheng District, Beijing, 100730, China.

Background: The optimal position for continuous adductor canal block (ACB) for analgesia after total knee anthroplasty (TKA) remians controversial, mainly due to high variability in the localization of the the adductor canal (AC). Latest neuroanatomy studies show that the nerve to vastus medialis plays an important role in innervating the anteromedial aspect of the knee and dives outside of the exact AC at the proximal end of the AC. Therefore, we hypothesized that continuous ACB at the proximal end of the exact AC could provide a better analgesic effect after TKA compared with that at the middle of the AC (which appeared to only block the saphenous nerve). Read More

BMC Musculoskelet Disord 2020 Aug 31;21(1):585. Epub 2020 Aug 31.

Department of Orthopedic Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai, 200090, China.

Background: Secondary osteonecrosis of the knee is a rare event. There are few reports regarding management of this condition. The aim of the present study is to report treatment outcomes for secondary osteonecrosis of the lateral condyle treated with unicompartmental knee arthroplasty (UKA). Read More

Minerva Anestesiol 2020 09 8;86(9):922-929. Epub 2020 Jul 8.

Department of Anesthesiology and Intensive Care Medicine, Park-Klinik Weissensee, Berlin, Germany.

Background: To identify anatomical structures using sonography can be challenging, yet it is a basic requirement for effective and safe ultrasound guided nerve blocks. In clinical routine, we find a wide variety in the visibility of anatomical structures. Aim of this study was to evaluate the feasibility of a newly developed visibility score for anatomical structures in ultrasound guided regional anesthesia. Read More

J Orthop Surg (Hong Kong) 2020 Jan-Apr;28(2):2309499020932037

Department of Orthopaedics and Traumatology, Pok Oi Hospital, Hong Kong SAR.

Purpose: Total knee replacement (TKR) is associated with post-operative pain. Femoral nerve block can relieve the pain but also affects the post-operative mobility. Saphenous nerve block (SNB) can improve analgesia without interfering mobilisation. Read More

Am Fam Physician 2020 06;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 07 23;36(7):1981-1982. Epub 2020 May 23.

Femoral nerve block 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 is a possible alternative resulting in less muscle weakness. Read More

Am J Sports Med 2020 06 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 06 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 05 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

A A Pract 2020 Jan;14(2):51-53

From the Division of Regional Anesthesiology and Acute Pain Medicine, New York Presbyterian Hospital, Weill Cornell Medicine, New York, New York.

Chronic inflammatory demyelinating polyneuropathy (CIDP) is a rare autoimmune disease that targets the peripheral nervous system. The literature on the use of regional anesthesia in CIDP is limited. We report a patient with CIDP who received a combined spinal-epidural (CSE) and saphenous and popliteal peripheral nerve blocks (PNBs) for ankle surgery. 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

J Cardiothorac Vasc Anesth 2020 03 18;34(3):845-846. Epub 2019 Oct 18.

Department of Anesthesia and Pain Medicine, Toronto Western Hospital, University of Toronto, Toronto, Canada.

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