• Pascal Sh Smulders, Werner Ten Hoope, Holger M Baumann, Jeroen Hermanides, Robert Hemke, BeenenLudo F MLFMDepartment of Radiology and Nuclear Medicine, Amsterdam UMC Location AMC, Amsterdam, The Netherlands., Roelof-Jan Oostra, Peter Marhofer, Philipp Lirk, and Markus W Hollmann.
• Department of Anesthesiology, Amsterdam UMC Location AMC, Amsterdam, The Netherlands.
• Reg Anesth Pain Med. 2024 Mar 4; 49 (3): 174178174-178.

IntroductionLow and high volume mid-thigh (ie, distal femoral triangle) and distal adductor canal block approaches are frequently applied for knee surgical procedures. Although these techniques aim to contain the injectate within the adductor canal, spillage into the popliteal fossa has been reported. While in theory this could improve analgesia, it might also result in motor blockade due to coverage of motor branches of the sciatic nerve. This radiological cadaveric study, therefore, investigated the incidence of coverage of sciatic nerve divisions after various adductor canal block techniques.MethodsEighteen fresh, unfrozen and unembalmed human cadavers were randomized to receive ultrasound-guided distal femoral triangle or distal adductor canal injections, with 2 mL or 30 mL injectate volume, on both sides (36 blocks in total). The injectate was a 1:10 dilution of contrast medium in local anesthetic. Injectate spread was assessed using whole-body CT with reconstructions in axial, sagittal and coronal planes.ResultsNo coverage of the sciatic nerve or its main divisions was found. The contrast mixture spread to the popliteal fossa in three of 36 nerve blocks. Contrast reached the saphenous nerve after all injections, whereas the femoral nerve was always spared.ConclusionsAdductor canal block techniques are unlikely, even when using larger volumes, to block the sciatic nerve, or its main branches. Furthermore, injectate reached the popliteal fossa in a small minority of cases, yet if a clinical analgesic effect is achieved by this mechanism is still unknown.© American Society of Regional Anesthesia & Pain Medicine 2024. No commercial re-use. See rights and permissions. Published by BMJ.

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