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Evaluation of the proximal adductor canal block injectate spread: a cadaveric study
  1. John Tran1,
  2. Vincent W S Chan2,
  3. Philip W H Peng2 and
  4. Anne M R Agur1
  1. 1 Division of Anatomy, Department of Surgery, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
  2. 2 Department of Anesthesia, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
  1. Correspondence to Mr John Tran, Division of Anatomy, Department of Surgery, University of Toronto Faculty of Medicine, Toronto, ON M5S 1A8, Canada; johnjt.tran{at}


Background and objectives Quadriceps sparing adductor canal block has emerged as a viable intervention to manage pain after total knee arthroplasty. Recent studies have defined ultrasound (US) landmarks to localize the proximal and distal adductor canal. US-guided proximal adductor canal injection has not been investigated using these sonographic landmarks. The objectives of this cadaveric study were to evaluate dye injectate spread and quantify the capture rates of nerves supplying articular branches to the knee joint capsule using a proximal adductor canal injection technique.

Methods A US-guided proximal adductor canal injection with 10 mL of dye was performed in seven lightly embalmed specimens. Following injection, specimens were dissected to document dye spread and frequency of nerve staining.

Results Following proximal adductor canal injection, dye spread consistently stained the deep surface of sartorius, vastoadductor membrane, aponeurosis of the vastus medialis obliquus, and adductor canal. The saphenous nerve, posteromedial branch of nerve to vastus medialis, superior medial genicular nerve and genicular branch of obturator nerve were captured in all specimens at the proximal adductor canal. There was minimal to no dye spread to the distal femoral triangle, anterior division of the obturator nerve and anterior branches of nerve to vastus medialis.

Conclusions This anatomical study provides some insights into the mechanism of analgesia to the knee following a proximal adductor canal injection and its motor sparing properties. Further clinical investigation is required to confirm cadaveric findings.

  • anatomy
  • knee joint innervation
  • adductor canal block

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  • Contributors JT, VWSC, PWHP, and AMRA contributed to the experimental design, data acquisition, analysis of data, drafting and revising the manuscript critically for important intellectual content.

  • 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.

  • Competing interests VWSC has received an honorarium from Philips Healthcare. PWHP received equipment support from SonoSite Fujifilm Canada. AMRA is an Anatomy Faculty with the Allergan Academy of Excellence.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.