Adductor Canal Block Ultrasound Anatomy in Volunteers

Determining The Location and Ultrasound Anatomy of Two Previously Described Adductor Canal Block Approaches in Volunteers.

There has been dispute about the location at which the adductor canal block should be performed (3-6). Two Common approaches have been used for ultrasound guided adductor canal blocks with the 'point of entry' being:

1. Point A: midway point between the ASIS and base of patella
2. Point B: Point which is 2-3 cm proximal to the site where the femoral artery becomes the popliteal artery as it traverses away from the sartorius muscle towards the femur at the adductor hiatus (2)

We want to determine ultrasound anatomy in healthy volunteers by:

1. Measuring the distance between Point A and Point B
2. Studying the ultrasound anatomy at Point A and B - Determine their location with respect to the adductor canal and femoral triangle.

This will allow us to determine which is the best site for performing an adductor canal block

Study Overview

• Status: Completed
• Conditions: Adductor Canal Block; Postop Analgesia for Knee
• Intervention / Treatment: Other: Ultrasound scanning of the lower limb in volunteers

Detailed Description

It is important to answer the primary question because of the variable length of the adductor canal and we would like to determine the optimal position to perform the adductor canal block.

The adductor canal typically contains the saphenous nerve, nerve to vastus medialis muscle and on occasion, the obturator nerve (1). The roof of adductor canal is the vasto-adductor membrane and its length is reported to range from 5.5 cm to 15 cm with a mean of 7.6 cm2 and would suggest the length of the AC is variable. We would like to determine the length of the AC with the use of ultrasound. The AC would be determined to begin at the apex of the femoral triangle and end just proximal to the adductor hiatus. The length and location of the AC would be important to characterize as the volume of local anesthetic used and associated quadriceps weakness could be of significance in a shorter AC.

There has been dispute about the location at which the adductor canal block should be performed (3-6). Point A has been disputed to be within the femoral triangle and would therefore be a femoral nerve block as suggested by a small body of evidence (4-5). Clinically, it is unclear if there is a difference between quadriceps muscle weakness between the two approaches although it could be hypothesized placing a block at point A would lead to more quadriceps muscle weakness. With information gathered from this study, we plan to perform a clinical study by performing the nerve blocks at these two points with different volumes of local anesthetic and compare the amount analgesia and motor weakness between the two different approaches.

60 Volunteers (30 male and 30 female) aged between 18 to 75 years with a body mass index of 18 to 35 kg/m2 will be included in this study. Volunteers with previous surgery or deformities of the lower extremity will be excluded from the study

This is an observational study without a control group. Several reference points will be marked by anatomical landmarks and/or ultrasound:

A. the anterior superior iliac spine (landmark); B. the base of the patella (landmark); C. apex of femoral triangle (ultrasound); and D. distal most portion of adductor canal (Point B described earlier; ultrasound).

The primary outcome measure we are looking at is the distance between Point A and Point B.

We also plan to measure the distance (in centimeters) from:

1. Base of patella to Point A
2. Base of patella to Point B
3. Apex of the femoral triangle

• Study Type: Observational
• Enrollment (Actual): 60

Contacts and Locations

Study Locations

• United States
  • Iowa
    • Iowa City, Iowa, United States, 52246
      • University of Iowa Hospitals and Clinics

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 75 years (ADULT, OLDER_ADULT)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

We aim to recruit volunteers who principally are healthcare employees at UIHC who mainly work in the Main Operating Rooms and Ambulatory Surgical Center Operating Rooms, mainly due to ease of access to ultrasonographic equipment. The subjects include anesthesiologists, certified registered nurse anesthetists, residents, interns, nurses, volunteers, technicians, administrative staff and other members of staff working in these areas.

Description

Inclusion Criteria:

• age 18-75 years, body mass index 18-35 kg/m2

Exclusion Criteria:

• no previous surgery or complaints from the lower extremity region

Study Plan

How is the study designed?

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Measurement 1	The distance in cm between Point A and Point B	One time assessment done during Ultrasound scanning of the lower extremity

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Measurement 2	The distance in cm between Point A and base of patella	One time assessment done during Ultrasound scanning of the lower extremity
Measurement 3	The distance in cm between Point B and base of patella	One time assessment done during Ultrasound scanning of the lower extremity
Measurement 4	The distance in cm between Apex of femoral triangle and base of patella	One time assessment done during Ultrasound scanning of the lower extremity

Collaborators and Investigators

• Sponsor: University of Iowa
• Investigators: Principal Investigator: Amanda Yap, MBBS, 319-356-1616

Publications and helpful links

General Publications

• Manickam B, Perlas A, Duggan E, Brull R, Chan VW, Ramlogan R. Feasibility and efficacy of ultrasound-guided block of the saphenous nerve in the adductor canal. Reg Anesth Pain Med. 2009 Nov-Dec;34(6):578-80. doi: 10.1097/aap.0b013e3181bfbf84.
• Bendtsen TF, Moriggl B, Chan V, Pedersen EM, Borglum J. Defining adductor canal block. Reg Anesth Pain Med. 2014 May-Jun;39(3):253-4. doi: 10.1097/AAP.0000000000000052. No abstract available.
• Tubbs RS, Loukas M, Shoja MM, Apaydin N, Oakes WJ, Salter EG. Anatomy and potential clinical significance of the vastoadductor membrane. Surg Radiol Anat. 2007 Oct;29(7):569-73. doi: 10.1007/s00276-007-0230-4. Epub 2007 Jul 7.
• Jaeger P, Zaric D, Fomsgaard JS, Hilsted KL, Bjerregaard J, Gyrn J, Mathiesen O, Larsen TK, Dahl JB. Adductor canal block versus femoral nerve block for analgesia after total knee arthroplasty: a randomized, double-blind study. Reg Anesth Pain Med. 2013 Nov-Dec;38(6):526-32. doi: 10.1097/AAP.0000000000000015.
• Bendtsen TF, Moriggl B, Chan V, Pedersen EM, Borglum J. Redefining the adductor canal block. Reg Anesth Pain Med. 2014 Sep-Oct;39(5):442-3. doi: 10.1097/AAP.0000000000000119. No abstract available.
• Bendtsen TF, Moriggl B, Chan V, Borglum J. Basic Topography of the Saphenous Nerve in the Femoral Triangle and the Adductor Canal. Reg Anesth Pain Med. 2015 Jul-Aug;40(4):391-2. doi: 10.1097/AAP.0000000000000261. No abstract available.

Study record dates

Study Major Dates

• Study Start (ACTUAL): May 1, 2017
• Primary Completion (ACTUAL): June 16, 2017
• Study Completion (ACTUAL): June 16, 2017

Study Registration Dates

• First Submitted: December 28, 2016
• First Submitted That Met QC Criteria: December 28, 2016
• First Posted (ESTIMATE): January 2, 2017

Study Record Updates

• Last Update Posted (ACTUAL): December 7, 2017
• Last Update Submitted That Met QC Criteria: December 5, 2017
• Last Verified: November 1, 2017

More Information

Terms related to this study

• Other Study ID Numbers: 201612345

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO