Bagaria Vaibhav, Kulkarni Rajiv V, Valavi Anisha, Choudhury Himanshu, Dhamangaonkar Anoop, Sahu Dipit
Department of Orthopaedics, Sir H N Reliance Foundation Hospital, Mumbai, India.
Department of Radiology, Sir H N Reliance Foundation Hospital, Girgaum, Mumbai, India.
Knee Surg Relat Res. 2020 Sep 21;32(1):48. doi: 10.1186/s43019-020-00066-z.
Adductor canal block (ACB) is one of the preferred methods of analgesia in total knee arthroplasty (TKA). However, conventionally its use is time-consuming, requires ultrasound guidance, a trained anaesthesia team and adherence to strict asepsis by members of the allied teams. This study was done to assess the feasibility and safety of direct adductor canal block (DACB) as a part of surgeon-administered periarticular infiltration.
Thirty computed tomography (CT) angiography films of the patients were retrospectively reviewed. The trajectory of the needle placement for a DACB in relation to the target region of the adductor block was determined. Fourteen knees in seven cadavers, were dissected through a medial parapatellar approach to perform TKA. After administering the DACB using the technique based on CT data, dissection was carried out to ascertain the correct placement of the dye by visualising the stained areas.
The angle of approach in the coronal plane from the entry point to the medial high point and to the adductor hiatus was 10.2° (8-14°) and 6° (3.8-11°), respectively. The angle of approach in the sagittal plane from the entry point to the medial high point and to the adductor hiatus was 7° (5-10.5°) and 29° (19-43°), respectively. In all the 14 cadaveric knees, we confirmed the correct placement of the methylene blue dye as demonstrated by the staining of the adductor canal.
The study demonstrates the feasibility of the DACB. This surgeon-driven technique is likely to reduce the cost of the procedure, reduce operating room time and also eliminate the risks of surgical-site contamination.
内收肌管阻滞（ACB）是全膝关节置换术（TKA）中首选的镇痛方法之一。然而，传统上其应用耗时，需要超声引导、训练有素的麻醉团队以及相关团队成员严格遵守无菌操作。本研究旨在评估直接内收肌管阻滞（DACB）作为外科医生实施关节周围浸润的一部分的可行性和安全性。
回顾性分析30例患者的计算机断层扫描（CT）血管造影影像。确定了与内收肌阻滞目标区域相关的DACB针放置轨迹。对7具尸体的14个膝关节，通过髌旁内侧入路进行解剖以实施TKA。使用基于CT数据的技术进行DACB后，进行解剖以通过观察染色区域确定染料的正确放置。
在冠状面从进针点到内侧高点以及到内收肌裂孔的进针角度分别为10.2°（8 - 14°）和6°（3.8 - 11°）。在矢状面从进针点到内侧高点以及到内收肌裂孔的进针角度分别为7°（5 - 10.5°）和29°（19 - 43°）。在所有14个尸体膝关节中，我们证实了亚甲蓝染料的正确放置，内收肌管出现染色。
本研究证明了DACB的可行性。这种由外科医生主导的技术可能会降低手术成本、减少手术室时间并消除手术部位污染的风险。
