Adductor Canal Block

(Saphenous Nerve)

Dr. Victor Smida

Spitalul Clinic de Urgenta pentru Copii “Louis Turcanu”, Timisoara
 Anatomy

• sensory branch of femoral

nerve

• innervates medial aspect of

the leg + superficial
structures of the knee

• part of adductor canal

 Adductor Canal Block (Saphenous
Nerve)
Indications:
• Analgesia for knee surgery
• Skin of the medial aspect of the leg
(ankel/foot surgery)
• + sciatic nerv block (foot amputation,
ankle fracture

Goal: local anesthetic spread around SaN

Tranducer:linear or curved (larger patients)
Needel: 22 G; 5 – 8 cm
 Adductor Canal Block (Saphenous
Nerve)
Contraindications:

• patient refusal
• hematoma/infection at the needle insertion site
• allergy to local anesthetic
• nerve damage
• myositis of quadriceps
• coagulopathy.
 Adductor Canal Block (Saphenous
Nerve)
Sensory block:
• anesthesia of the skin from the medial
aspect of leg and knee to the ankel joint
and foot

LA volume: 10 ml
• bupivacaine 0.25%/ropivacaine 0.25%,
0.5%

• > 15 ml may block quadriceps muscle

• larger volume: spread into popliteal fossa

and plexsus
 Adductor Canal Block (Saphenous
Nerve)
Patient position
• supine
• thigh abducted and externally
rotated

External landmarks
• middle third of the thigh
 Adductor Canal Block (Saphenous
Nerve)

Transducer position

• transverse orientation
• mddle third of the thigh
 Adductor Canal Block (Saphenous
Nerve)
Scanning
• identify the femoral artery deep to
the sartorius muscle
• identify the limits of the femoral
tringle and adductor canal –
medial border of sartorius m.
meets medial border of ALM.
• scan distally – artery located in the
middle of sartorius m. and
ultrasound image of ALM becoms
shorter
 Adductor Canal Block (Saphenous
Nerve)
Needle insertion
• in-plane, lateral to medial direction

• advance towards femoral artery

and saphenous nerve

• after negative aspiration, inject 1-2

ml of LA to confirm the proper
injection site

• complete the block with 10 ml

 Adductor Canal Block (Saphenous Nerve)
Tips
Color Doppler: if the artery can not be visualized
• color Doppler/power Doppler
• scan the artery at the femoral crease and follow the artery distally

LA volume: not more than 10 ml

Nerve visualistion: hyperechoic, nerve may not always be seen

• inject 10 ml LA next to the lateral aspect of femoral artery
• saphenous nerve often becomes better visualized after injection

In-plane/out-of-plane: both (out-of-plane easier in larger patients)