ABDUCTOR CANNAL BLOCK

The adductor canal block is one way femoral nerve block, with the approach to the lower
thighs so that most of the motor innervation of the anterior femur is not manipulated.

Most of strength at the anterior femur remain on this block, thus making mobilization and
medical rehabilitation faster and safer
 ANATOMY

• The saphenous nerve is located

in the adductor canal.
• This canal is also called a
Hunter Canal or sub-sartorial
canal, an intermuscular
aponeurotic canal in the middle
third of the thigh
 GENERAL PREPARATION

Seek patient approval and inform

Before you begin, make sure there
them of possible procedures,
is an appropriate indication for
successes, durations, advantages
adductor canal blocks and no
and disadvantages, and alternative
contraindications.
actions of this block
 SPECIFIC EQUIPMENTS

• Needle block short-bevel, 22-gauge 100 mm

• Skin antiseptic solution.
• Sterile gloves/handschoen.
• 1-2 ml 1% lignocaine for local anesthetic infiltration in conscious patients.
• Low volume block: 5-10 ml long-acting local anesthesia, eg 0.25-0.5% Bupivacaine, Levobupivacaine or
0.2-0.75% Ropivacaine.
• High volume block: 20-30 ml of local anesthetic of long duration.
• Portable ultrasound machine
• Nerve stimulator
PROCEDURE

Positioning the
Positioning the
patient supine with
patient supine with
knees slightly flexed
knees slightly flexed
and feet directed to
and feet directed to
the external (position
the external (position
like frog legs).
like frog legs).
 PROCEDURE

ultrasound probe
Stand on the side on the anterior Identify the femur
of the area to be thigh of the (usually at 3-5cm
Clear the action Use 8 - 14 mHz
blocked with an patient, depth though
area with 0.5% ultrasound linear
ultrasound on the approximately varied) and slide
Chlorhexidine probe, 2 - 4 cm
opposite side of midpoint between the probe to
spray depth
the screen facing the inguinal folds medial until the
you and the medial Sartorius muscle
condyle.
 NOTICE THE FEMUR (BOTTOM RIGHT) WITH THE
VASTUS INTERMEDIUS MUSCLE ABOVE IT. THE
ADDUCTOR CANAL IS LOCATED UNDER THE SARTORIUS
ADDUCTOR CANAL IS BELOW SARTORIUS.
 PROCEDURE

saphenous nerves
are almost always The correct probe Use the needle
too small to be well position is exactly insertion approach
The femoral artery visualized and this Optimize images, proximal to the from the lateral to
is located just technique aims to adjust the depth, place where the the medial and
below this muscle flooding the local and adjust the femoral artery make sure your
in the adductor anesthesia under frequency as enters the posterior needle tip is
canal. Sartorius and needed. part and the probe always visible on
around the femoral must be positioned ultrasound
artery perpendicular to the
artery
 Local anesthesia is spreading under
Sartorius into the adductor canal

The needle crosses the sartorius and

ends in the adductor canal (the in-
plane needle approach).
 PROCEDURE

Continue the
Push forward the confirm your remaining dose of
needle into the needle tip right injections, do the
adductor canal. Aspirate and inject within the adductor aspiration every 5
This needle Use nerve canal. consider the
a test dose of 1 ml ml. Continue
placement can be stimulator (if any) possibility of
of local anesthetic monitoring
achieved by to confirm intravascular
solution. patients carefully,
crossing the needle placement note the signs of
sartorius or vastus and consider local anesthetic
medialis muscle. repositioning. toxicity
 FASCIA ILIACA COMPARTMENT
BLOCK

• The adductor canal block is one way femoral nerve block, with the approach to the lower thighs so
that most of the motor innervation of the anterior femur is not manipulated.
• Most of strength at the anterior femur remain on this block, thus making mobilization and medical
rehabilitation faster and safer
 ANATOMY
Innervation of lower extremity was given through four main nerves :
sciatic nerve, femoral nerve, obturator nerve and lateral cutaneus nerve
This compartment enables the deposition of local anestesia with
a volume that could sufficiently spread to at least two out of
three main nerves that innervates
The medial, anterior and lateral thigh with one simple injection,
which is cutaneus femoral nerve and femoral nerve

Key points :
- Innervation from medial,
anterior and lateral thigh
originated from L2-4.
- Fascia iliaca compartment
contains three out of four main
nerves that innervate the feet.
- Local anesthesia that injected
in this area is believed that it
could only reach the femoral
and lateral cutaneus nerve.
INDICATION
• The purpose is to reduce the need of systemic
analgesia like opioid and non steroid anti
inflamatory drug, along with their side effects.
• This is necessary for elderly, the group with the
largest number of femoral column fracture
• Pre operative analgesia for patient with femoral
neck fracture or femoral shaft fracture
• Analgesia for plaster application on children
with femoral fracture
CONTRAINDICATION
• Refusal from the patient.
• Alergy or previous anaphylactic reaction
towards local anesthesia.
• Inflamation or infection at the injection area.
• Previous femoral bypass or nearby the graft
area.
• Anticoaculation – INR > 1.5
(Consider clopidogrel aspirin / high dose aspirin /
heparin with low molecular weight)
 LANDMARK PROCEDURE
The landmark of this procedure is the anterior superior iliac spine and ipsilateral side of tuberculum
pubicum
 COMPLICATION

• Intravascular injection
• Intravascular injection
• Toxicity of local anesthesia
• Toxicity of local anesthesia
• Permanent or temporary damage of the nerve
• Permanent or temporary damage of the nerve
• Infection
• Infection
• Failed block
• Failed block
• Secondary injury due to numbess / weakness of the lower limb
• Secondary injury due to numbess / weakness of the lower limb
• Alergic towards the used drug
• Alergic towards the used drug
Overally, FICB has low risk profile, minimize the risk of intravascular injection and mechanical nerve injury,
Overally, FICB has low risk profile, minimize the risk of intravascular injection and mechanical nerve injury,
and the use of amides local anesthesia
and the use of amides local anesthesia
 USG GUIDING

The key point in using the USG : transducer must be placed at the
level of femoral folds and the probe parallel with the folds.
- Place the tip of the needle under
the fascia iliaca
- Approximately on lateral one
third of the line that connects
superior anterior iliac spine and
pubic tubercle
- Injection was made few
centimeter laterally towards
femoral artery
- Insert the relatively big volume
(30 – 40 ml) of local anesthesia
until it distributes laterally towards
iliac spine and medially towards
femoral nerve