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Abstract
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Background and Aims The nerve to vastus medialis (NVM) contributes to the innervation of the knee capsule through the intramuscular, extramuscular, and deep genicular nerves. This nerve can be identified and blocked using dynamic ultrasound scanning in the distal femoral triangle. However, do all anaesthetists routinely search for and block this nerve during the distal femoral triangle block?
Methods This project surveyed 27 anaesthetists (7 consultants, 17 registrars, and 3 core trainees) regarding their practice of distal femoral triangle block. A sonoanatomy picture capturing the NVM and saphenous nerve in the distal femoral triangle region was obtained from a staff volunteer and saved on an iPad (figure 1). Each anaesthetist was asked to draw their needle trajectory and circle the nerve structures on the iPad image as if they were performing the block in real time.
Results Out of 27 participants, 23 (85%) correctly delineated circles around the saphenous nerve, while only 5 (18.5%) accurately marked the NVM. Additionally, 3 (11%) participants drew a needle trajectory passing through the NVM.
Conclusions The majority of participants did not target the NVM as part of their distal femoral triangle block. A minority of participants passed their block needle through the nerve, which could lead to nerve damage in clinical practice. To enhance awareness and safety, we introduced an educational poster illustrating the sonoanatomy of the NVM (figure 2) and integrated it into a formal teaching course (Plan A blocks) in our department.
