Background and Aims We propose the ISAFE technique for ACC placement ( Figures - 1 & 2 ) to avoid the proximity of catheter tip to Femoral Vein-FV, an accidental venous-puncture, reduce potential trauma to saphenous nerve - SN, and prevent ACC - dislodgement.
Methods ACC were inserted in sixteen total knee arthroplasty (TKA) patients postoperatively to avoid ACC displacement by the intraoperative thigh-tourniquet.
5 mL/h disposable elastomeric infusion-pump (Baxter-International-Inc.,IL,US) of 250 ml- Ropivacaine 0.2% infused over 48 hours-outpatient setting.
The ISAFE approach:
Needle insertion: level of the mid-adductor canal, mid-sartorius, in-plane (lateral to medial)
Needle advancement: piercing through the posterior fascia of Sartorius muscle-SM approximately 1–2 cm lateral to Femoral Artery-FA, entering adductor canal (Figure 1).
ISAFE hydro-dissection: Needle angle is then decreased to avoid FV and advanced into the inter-fascial space between FA and SM (Figure 1). Hydro-dissection is necessary to open the inter-fascial space and separating FA from SM.
Catheter insertionat the 11 o’clock position anteromedial position to FA, facilitating over-threading catheter (Figure-2). We recommend threading the catheter approximately 3–5 mm past FA.
Results No local-anesthetic systemic toxicity, intravascular puncture, or ACC-dislodgments was noted.
9-patients (56.25%) required NO opioid analgesia over three-day postoperative period.
Mean cumulative opioid-consumption (in oral morphine-equivalent) on postoperative days- 2–3 were 10.78 ± 14.33 mg and 12.50 ± 18.68 mg, respectively.
Conclusions The ISAFE approach for ACC placement is potentially safer, feasible, and reliable for maintaining analgesia after TKA.
The ISAFE technique, while feasible for practitioners in regional anesthesia, has a learning-curve and requires training.
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