China
Africa
Explore chapters and articles related to this topic
Other Regional and Local Analgesia
Published in Pamela E. Macintyre, Stephan A. Schug, Acute Pain Management, 2021
Pamela E. Macintyre, Stephan A. Schug
However, after knee surgery, in particular total knee replacement, femoral nerve blocks impair early functional recovery, although they are superior to systemic opioid analgesia and comparable with epidural analgesia with fewer adverse effects (Fischer et al, 2008). Therefore, adductor canal blocks with minimal effect on motor function are currently the preferred block for total knee replacement as they improve functional recovery (Kuang et al, 2017). Local infiltration analgesia (LIA) has become an increasingly viable alternative to femoral nerve blocks, if performed with the appropriate technique (Andersen & Kehlet, 2014)—see Section 10.5. Continuous lumbar plexus blockade is also effective but not recommended as it carries an increased risk of complications (Fischer et al, 2008).
Lower Limb
Published in Bobby Krishnachetty, Abdul Syed, Harriet Scott, Applied Anatomy for the FRCA, 2020
Bobby Krishnachetty, Abdul Syed, Harriet Scott
The adductor canal is a pyramidal-shaped tunnel running from the apex of the femoral triangle to the adductor hiatus. It runs anterolateral to the vastus medialis muscle and posteromedially to the adductor longus and magnus muscles. Important contents of this canal include the saphenous nerve, nerve to vastus medialis with femoral artery and vein.
Osteoporotic distal femoral fractures
Published in Peter V. Giannoudis, Thomas A. Einhorn, Surgical and Medical Treatment of Osteoporosis, 2020
Richard Stange, Michael J. Raschke
The principles of postoperative management of elderly patients apply here: remedying blood loss, preventing decubitus complications, managing anticoagulation, and treating the comorbidities (25,34). The lessons drawn from managing elderly patients undergoing surgery for femoral neck fracture are relevant, especially including teamwork between geriatric and orthopedic surgeons (20). Pain management should be up-to-date and multimodal, avoiding morphine derivatives as far as possible. A combination of local therapeutic injections at the end of surgery and the use of an adductor canal catheter is particularly effective (35). The main issue is resumption of full weight-bearing, which should be immediate whenever possible.
Postoperative analgesic effectiveness of ultrasound guided combined femoral - sciatic nerve block versus combined adductor canal block – I PACK block in patients undergoing total knee arthroplasty: A double- blind randomized study
Published in Egyptian Journal of Anaesthesia, 2023
Rania Maher Hussien, Mohamed Sabry Abdel-Badea Ismail, Amir Ibrahim Mohamed Salah, Ahmed Nagah Elshaer, Ayman Ahmad Elsayed Abdellatif, Tamer Nabil Abdelrahman
In the A-I group, patients received an adductor canal block (ACB) as depicted in Figure 2A. We positioned them in a supine position with externally rotated legs and slightly flexed knees (frog-leg position). With a linear transducer (6–13 MHz) at the intersection of the medial condyle and inguinal crease, we visualized the saphenous nerve, which appeared as a hyper-echoic structure lateral to the femoral artery. Using the in-plane method, we inserted the same 22-gauge needle in a lateral-to-medial orientation and administered 20 mL of 0.25% bupivacaine after careful aspiration. While the patient remained in the frog-leg position, we performed an IPACK block as shown in Figure 2B. Using a linear probe (6–13 MHz) at the popliteal crease, we visualized the popliteal fossa and identified the condyles’ hyperechoic line. With the in-plane approach, we inserted the same 22-gauge needle in the medial thigh between the popliteal artery and the femur, maintaining a safe distance from the peroneal nerve and the popliteal artery. After careful aspiration, we administered 20 mL of 0.25% bupivacaine.
Acute postoperative pain management with percutaneous peripheral nerve stimulation: the SPRINT neuromodulation system
Published in Expert Review of Medical Devices, 2021
Rodney A. Gabriel, Brian M. Ilfeld
Anterior Cruciate Ligament Reconstruction. The use of ultrasound-guided percutaneous PNS has also been described in a small feasibility study for patients undergoing anterior cruciate ligament reconstruction[13]. Like the previous feasibility trials described, patients were randomized to receive either sham or active stimulation for 5 minutes, then crossover the next 5 minutes, followed by 30 minutes of active stimulation. Ten patients were recruited and received PNS to the femoral nerve, which was placed days before surgery. During the initial 5-minute treatment period, those who received active stimulation had a 7% decrease in pain over that time period, while those in the sham group experienced a 4% increase in pain (potentially because of the unblocked sciatic nerve contributing to the apparent inadequate analgesia). Those who initially received sham had an 11% decrease in pain during the crossover treatment. Postoperatively, 80% of patients required additional continuous adductor canal nerve block for rescue analgesia during the first 2 days after surgery. After that, both pain scores and opioid use were minimal.
The Efficacy and Safety of Combined Adductor Canal Block with Periarticular Anesthetic Injection Following Primary Total Knee Arthroplasty: A Meta-Analysis
Published in Journal of Investigative Surgery, 2020
Xiaowen Zhu, Feng Wang, Weiqi Ling, Xiaoyu Dai
Adductor canal block (ACB) has emerged as a component of this multimodal program, with the benefit of maintaining a sensory block for pain control while minimizing motor blockade to the quadriceps/extensor mechanism, which may help to facilitate functional recovery [6]. Recently, PAI has also demonstrated success in reducing postoperative pain. This method provides analgesia by directly applying analgesics into the surgical site. In theory, PAI has the advantage of sensory nerve block comparable to ACB, without the risks of quadriceps weakness, falls and neurological impairment [7–9]. While ACB is known to cover most of the anteromedial aspect of the knee joint, it does not provide the coverage of the lateral and posterior aspects of the knee that is obtained with PAI [10]. Therefore, whether combining these two methods can improve and prolong analgesia is a question worth exploring.