Summary

The purpose of this study was to investigate the novel placement of a catheter placed between the muscles that make up the adductor canal accessed during a standard para-patella surgical approach in TKA.

Abstract

Introduction

Total knee arthroplasty (TKA) is considered to be one of the more painful medical procedures routinely performed today. Pain management in TKA patients is challenged by a postoperative requirement for early ambulation along with a concurrent goal to reduce opioid consumption while reducing the hospital stay. Peripheral nerve blocks (PNB) address these concerns to some degree, with femoral nerve block, and adductor canal block being the most commonly used regional nerve blocks for surgeries performed around the knee joint.

Purpose

The purpose of this study was to investigate the novel placement of a catheter placed between the muscles that make up the adductor canal accessed during a standard para-patella surgical approach in TKA. This catheter placement was compared to standard anesthesia placements performed under ultrasound guidance.

Study Design: Cadaveric Study

Methods

The study was conducted in 12 fresh-frozen human cadaveric lower limbs

Results

Using colored indicator dyes to clearly locate the site of surrogate peripheral nerve blocks, this cadaveric study demonstrated that a standard surgical approach to the knee provides an excellent exposure to the medial intermuscular septum adjacent to the adductor canal. Through a standard anterior surgical approach to the knee a novel intraoperative catheter placement technique can be performed to provide a peripheral nerve block for patients undergoing TKA comparable or potentially superior to standard ultrasound guided anesthesia block techniques.

Conclusion

The present cadaveric study has demonstrated that a standard approach for a TKA provides an excellent exposure to the medial intermuscular septum adjacent to the adductor canal, allowing for placement of a PNB. This novel intraoperative catheter placement technique administered by the surgeon is a safe and efficient method to provide for extended relief of post-TKA pain.


Keywords: Adductor Canal Blocks, pain management, Total Knee Arthroplasty