• David F Johnston, Nicholas D Black, Rebecca Cowden, Lloyd Turbitt, and Samantha Taylor.
• Department of Anaesthesia and Perioperative Medicine, The Royal Victoria Hospital, Belfast Trust, Belfast, UK davidf.johnston@belfasttrust.hscni.net.
• Reg Anesth Pain Med. 2019 Jan 1; 44 (1): 39-45.

Background And ObjectivesThe nerve to vastus medialis (NVM) supplies sensation to important structures relevant to total knee arthroplasty via a medial parapatellar approach. There are opposing findings in the literature about the presence of the NVM within the adductor canal (AC). The objective of this cadaveric study is to compare the effect of injection site (distal femoral triangle (FT) vs distal AC) on injectate spread to the saphenous nerve (SN) and the NVM.MethodsFour unembalmed fresh-frozen cadavers acted as their own control with one thigh receiving 20 mL of dye injected via an ultrasound-guided injection in the distal FT while the other thigh received an ultrasound-guided injection in the distal AC. A standardized dissection took place 1 hour later to observe the extent of staining to the NVM and SN in all cadaver thigh specimens.ResultsIn all specimens where the injectate was introduced into the distal FT, both the SN and NVM were stained. In contrast, when the dye was administered in the distal AC only the SN was stained.ConclusionsOur findings suggest that an injection in the distal AC may be suboptimal for knee analgesia as it may spare the NVM, while an injection in the distal FT could provide greater analgesia to the knee but may result in undesirable motor blockade from spread to the nerve to vastus intermedius.© American Society of Regional Anesthesia & Pain Medicine 2019. No commercial re-use. See rights and permissions. Published by BMJ.

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