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Spread of dye injectate in the distal femoral triangle versus the distal adductor canal: a cadaveric study
  1. David F Johnston1,
  2. Nicholas D Black2,
  3. Rebecca Cowden3,
  4. Lloyd Turbitt1 and
  5. Samantha Taylor4
  1. 1 Department of Anaesthesia and Perioperative Medicine, The Royal Victoria Hospital, Belfast Trust, Belfast, UK
  2. 2 Department of Anesthesia and Perioperative Medicine, Toronto Western Hospital, Toronto, ON, Canada
  3. 3 Undergraduate, Queen's University Belfast, Belfast, UK
  4. 4 Centre for Biomedical Sciences Education, Queen's University Belfast, Belfast, UK
  1. Correspondence to Dr David F Johnston, Department of Anaesthesia and Perioperative Medicine, The Royal Victoria Hospital, Belfast Trust, Belfast BT12 6BA, UK; davidf.johnston{at}belfasttrust.hscni.net

Abstract

Background and objectives The 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.

Methods Four 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.

Results In 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.

Conclusions Our 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.

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Footnotes

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Provenance and peer review Not commissioned; externally peer reviewed

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