![]() Here are the steps I use to place non-stimulating adductor canal catheters pre-operatively, using a catheter-through-needle approach and ultrasound guidance. The corresponding numbers were 74% and 92% for the orthopedic patients.ĭyloject won't replace opioids, as the manufacturer is quick to point out, but it's one more way to help minimize their use. In the abdominal/pelvic group, 63% of patients took rescue medication in the first 48 hours after surgery, compared with 92% of those given a placebo. In 2 controlled studies, patients who'd had abdominal/pelvic surgery or orthopedic surgery had lower pain scores and were less likely to require rescue medication (IV morphine) after being given Dyloject. It can be administered in a small-volume intravenous bolus over 15 seconds, versus the 15 to 30 minutes that can be needed to administer full doses of other injectable non-opioid analgesics. Thanks to a recent FDA approval, multimodal pain strategists have another player to consider - an injectable NSAID that reduces opioid consumption when given post-operatively.ĭyloject (diclofenac sodium), manufactured by Hospira, also adds a level of convenience. That's why it's not simply called a "saphenous nerve block" when it's used for knee analgesia.įAST RELIEF Dyloject can be administered in a small-volume bolus in just 15 seconds. The saphenous nerve is probably the most important, but the total analgesia is likely due to the cumulative effect of blocking all 3 branches. The canal contains several nerve branches that provide sensory innervation to the knee, including the saphenous nerve, the nerve to vastus medialis and the posterior branch of the obturator nerve. The technique would be very challenging to perform solely with landmarks, but with high-frequency ultrasound and a little practice, you can easily visualize the muscles, vessel landmarks, needle and injected local anesthetic. The anatomical boundaries of the adductor canal are the sartorius muscle medially, the vastus medialis anterolaterally and the adductor magnus (and femoral artery and vein) posteriorly. The block is performed with an injection of local anesthetic at the mid-thigh. Mariano, MD, concludes that "when not contraindicated, intraoperative neuraxial anesthesia combined with a continuous adductor canal block and a multimodal medication regimen for post-operative pain control is the best analgesic protocol for knee arthroplasty." They carry the same very rare risks as other nerve blocks, such as nerve injury and local anesthesia toxicity, but a nerve injury that occurs with an adductor canal block is likely to be a sensory neuropathy, as opposed to the quadriceps weakness and atrophy that can result from a femoral nerve injury.Ī recent study ( /nJU5nT) by Stanford's Christopher Webb, MD, and Edward R. But unlike femoral blocks, they spare the quadriceps so the leg can maintain motor strength. Similar to traditional femoral nerve blocks, adductor canal blocks provide rapid-onset analgesia. Winchester's step-by-step video on how to place an adductor canal block at bit.ly/blockjocksadductorcanal.
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