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Anatomy and Clinical Implications of the Ultrasound-Guided Subsartorial Saphenous Nerve Block
  1. Theodosios Saranteas, MD, PhD*,
  2. George Anagnostis, MD*,
  3. Tilemachos Paraskeuopoulos, PhD,
  4. Dimitrios Koulalis, MD,
  5. Zinon Kokkalis, MD,
  6. Mariza Nakou, MD*,
  7. Sofia Anagnostopoulou, PhD and
  8. Georgia Kostopanagiotou, PhD*
  1. From the *2nd Department of Anesthesia and Cardiovascular Critical Care, School of Medicine, Attikon Hospital,
  2. Department of Anatomy, School of Medicine, and
  3. 2nd Department of Orthopaedic Surgery, School of Medicine, Attikon Hospital, University of Athens, Athens, Greece.
  1. Address correspondence to: Theodosios Saranteas, MD, PhD, 14, Kerdillion str, Gerakas, Athens, Greece (e-mail: thsaranteas{at}gmail.com).

Abstract

Background: We evaluated the anatomic basis and the clinical results of an ultrasound-guided saphenous nerve block close to the level of the nerve's exit from the inferior foramina of the adductor canal.

Methods: The anatomic study was conducted in 11 knees of formalin-preserved cadavers in which the saphenous nerve was dissected from near its exit from the inferior foramina of the adductor canal. The clinical study was conducted in 23 volunteers. Using a linear probe, the femoral vessels and the sartorius muscle were depicted in short-axis view at the level where the saphenous nerve exits the inferior foramina of the adductor canal. Ten milliliters of 1.5% lidocaine was injected into the compartment structured by the sartorius muscle and the femoral artery.

Results: The saphenous nerve was found to exit the adductor canal from its inferior foramina in 9 (81.8%) of 11 and at a more proximal level in 2 (18.2%) of 11 of the anatomic specimens. In a single specimen (9%), the saphenous nerve was formed by the anastomosis of 2 branches. In all the dissections, the saphenous nerve, after exiting the adductor canal, passed between the sartorius muscle and the femoral artery. Of the 23 volunteers, 22 responded with a complete sensory block, whereas a single volunteer demonstrated no sensory blockade. None of the volunteers experienced a motor block of the hip flexors and knee extensors.

Conclusions: Ultrasound-guided injection directly caudally from the inferior foramina of the adductor canal, between the sartorius muscle and the femoral artery, seems to be an effective approach for saphenous nerve block.

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