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Comparison of migration rates between traditional and tunneled adductor canal block catheters: a randomized controlled trial
  1. Yehoshua Gleicher1,
  2. Hermann dos Santos Fernandes1,
  3. Sharon Peacock1,
  4. Tural Alekberli1,
  5. Vitaliano Di Grazia1,
  6. Regine Estrellas1,
  7. Jesse Wolfstadt2,
  8. John Matelski3 and
  9. Naveed Siddiqui1
  1. 1Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
  2. 2Surgery, Division of Orthopaedics, Sinai Health System, Toronto, Ontario, Canada
  3. 3Biostatistics Research Unit, University of Toronto, Toronto, Ontario, Canada
  1. Correspondence to Dr Hermann dos Santos Fernandes, Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Canada; hermannfernandes{at}


Introduction Total knee arthroplasty is associated with significant postoperative pain. Continuous adductor canal blocks via an inserted adductor canal catheter are effective analgesia interventions with the advantage of decreasing quadriceps weakness and the potential of extending the analgesic effect. The classical adductor canal catheter insertion technique may have a high likelihood of catheter dislodgement out of the canal. The interfascial plane between the sartorius muscle and femoral artery (ISAFE) approach has the potential of decreasing the adductor canal catheter migration. The purpose of this study was to evaluate the incidence of catheter dislodgment to outside the adductor canal, for ISAFE and classical approaches. We hypothesized that ISAFE approach would result in a lower dislodgment rate.

Methods Ninety-seven patients for unilateral total knee arthroplasty were included and randomized to either ISAFE intervention group or conventional group. The primary outcome was the incidence of adductor canal catheter dislodged to outside the adductor canal, on ultrasound evaluation, 24 hours after the surgery. Secondary outcomes were pain scores, opioid consumption and continuous adductor canal block related complications for the first 48 hours after surgery.

Results The catheters placed using ISAFE approach had a lower rate of dislodgement in comparison to the control group (18.6% vs 44.9%, respectively, p=0.01), at 24 hours after surgery; and lower pain scores for rest, on the first two postoperative days.

Conclusions ISAFE group had a significantly lower rate of dislodgement at 24 hours. The continuous adductor canal block analgesic benefit for knee arthroplasty depends on the position of the tip of the catheter inside the adductor canal.

  • Nerve Block
  • analgesia
  • Lower Extremity

Data availability statement

Data are available on reasonable request.

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Data availability statement

Data are available on reasonable request.

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  • Contributors YG helped design the study, collect the data, analyze the data, and helped write the manuscript. HSF helped design the study, analyze the data, prepare the manuscript, and is also responsible for the overall content as guarantor. SP helped design the study and review the manuscript. TA helped with data collection. VDG helped with data collection. RE helped with data collection. JW helped design the study. JM performed the statistical analysis. NS helped design the study, analyze the data, and prepare the manuscript.

  • 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 None declared.

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