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B90 Inter-fascial space between sartorius muscle and femoral artery – ISAFE: novel approach for adductor canal catheter – ACC
  1. T Alekberli1,
  2. H dos Santos Fernandes1,
  3. N Siddiqui1,
  4. S Peacock1,
  5. E Vidal1,
  6. J Wolfstadt2 and
  7. Y Gleicher1
  1. 1Department of Anesthesia and Pain Management, University of Toronto, Toronto, Canada
  2. 2Department of Orthopedic Surgery, University of Toronto, Toronto, Canada


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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