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- DOI 10.18231/j.ijca.2025.077
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A new two in one approach to ultrasound guided anterior sciatic and adductor canal block for below knee surgeries
Background and Aims: Sciatic and saphenous nerve blocks are commonly performed at the midthigh level under ultrasound guidance, typically requiring two separate skin entry points. This traditional approach may increase procedural complexity and patient discomfort. This study evaluated a two-in-one technique to perform anterior sciatic and saphenous nerve blocks through a single skin puncture at the midthigh level, aiming to simplify the procedure. The primary objective was to assess the feasibility, clinical utility, and safety of this technique, while secondary objectives included evaluating procedural time, sensory and motor block onset, and the duration of postoperative analgesia.
Materials and Methods: The study included 60 patients aged 18 to 80 years, of either sex, with ASA status I-III, undergoing elective or emergency below-knee surgeries. The blocks were performed under ultrasound guidance, and procedural time, sensory and motor block onset, and duration of postoperative analgesia were recorded.
Results: The two-in-one technique was successfully performed in all patients with a single skin puncture. The mean procedural time was 11.4 ± 0.632 minutes. The average onset times for sensory and motor blocks were 6.8 ± 0.748 minutes and 11.6 ± 0.894 minutes, respectively. The mean duration of postoperative analgesia was 13 ± 0.748 hours.
Conclusion: This novel ultrasound-guided approach to anterior sciatic and adductor canal block at the midthigh level using a single skin puncture is a safe, reproducible, and clinically effective technique for achieving complete anesthesia for below-knee surgeries.
Keywords: Anterior sciatic block, Adductor canal block, Below-knee surgeries, Ultrasound-guided blocks.
References
- BECK GP. Anterior approach to sciatic nerve block. Anesthesiology. 1963;24:222–4.
- Mansour NY. Sub-sartorial saphenous nerve block with the aid of nerve stimulator. Reg Anesth. 1993;18(4):266–8.
- Gray AT, Collins AB. Ultrasound-guided saphenous nerve block. Reg Anesth Pain Med. 2003;28(2):148; author reply 148.
- Kumar A, Sinha C, Kumar A, Kumari P. Ultrasound-guided adductor and sciatic nerve block: Two in one approach at mid-thigh level. Saudi J Anaesth. 2017;11(3):368–70.
- Sample size estimation and power analysis for clinical research studies: Retraction. J Hum Reprod Sci. 2015;8(3):186.
- Stranding S. Gray's Anatomy, 39th Edition: The Anatomical Basis of Clinical Practice. AJNR Am J Neuroradiol. 2005;26(10):2703–4
- Dolan J. Ultrasound-guided anterior sciatic nerve block in the proximal thigh: an in-plane approach improving the needle view and respecting fascial planes. Br J Anaesth. 2013;110(2):319–20.
- Chan VW, Nova H, Abbas S, McCartney CJ, Perlas A, Xu DQ. Ultrasound examination and localization of the sciatic nerve: a volunteer study. Anesthesiology. 2006;104(2):309–14.
- Ota J, Sakura S, Hara K, Saito Y. Ultrasound-guided anterior approach to sciatic nerve block: a comparison with the posterior approach. Anesth Analg. 2009;108(2):660–5.
- Chantzi C, Saranteas T, Zogogiannis J, Alevizou N, Dimitriou V. Ultrasound examination of the sciatic nerve at the anterior thigh in obese patients. Acta Anaesthesiol Scand. 2007;51(1):132.
- Fornage BD. Peripheral nerves of the extremities: imaging with US. Radiology. 1988;167(1):179–82.
- Peer S, Kovacs P, Harpf C, Bodner G. High-resolution sonography of lower extremity peripheral nerves: anatomic correlation and spectrum of disease. J Ultrasound Med. 2002;21(3):315–22.
- Graif M, Seton A, Nerubai J, Horoszowski H, Itzchak Y. Sciatic nerve: sonographic evaluation and anatomic-pathologic considerations. Radiology. 1991;181(2):405–8.
- Panhuizen IF, Snoeck MM. Blokkade van de N. ischiadicus via echogeleide anterieure benadering (Ultrasound-guided anterior approach to sciatic nerve block). Ned Tijdschr Geneeskd. 2011;155: A2372.
- Krombach J, Gray AT. Sonography for saphenous nerve block near the adductor canal. Reg Anesth Pain Med. 2007;32(4):369–70.
- Marian AA, Ranganath Y, Bayman EO, Senasu J, Brennan TJ. A comparison of 2 ultrasound-guided approaches to the saphenous nerve block: adductor canal versus distal trans sartorial: A prospective, randomized, blinded, noninferiority trial. Reg Anesth Pain Med. 2015;40(5):623–30.
- Gautier PE, Lecoq JP, Vandepitte C, Harstein G, Brichant JF. Impairment of sciatic nerve function during adductor canal block. Reg Anesth Pain Med. 2015;40(1):85–9.
- Andersen HL, Andersen SL, Tranum-Jensen J. The spread of injectate during saphenous nerve block at the adductor canal: a cadaver study. Acta Anaesthesiol Scand. 2015;59(2):238–45.
- Nair A. Comments on 'relieving pain after arthroscopic knee surgery: ultrasound-guided femoral nerve block or adductor canal block?'. Turk J Anaesthesiol Reanim. 2018;46(3):248.
- Thiranagama R. Nerve supply of the human vastus medialis muscle. J Anat. 1990;170:193–8.
- Watanabe T, Mera H, Seino Y. Identifying nerve to vastus medialis at adductor canal entry. J Anesth. 2023;37(5):813–4.
- Burckett-St Laurant D, Peng P, Girón Arango L, Niazi AU, Chan VWS, Agur A, et al. The nerves of the adductor canal and the 504 Raj S K et al. / Indian Journal of Clinical Anaesthesia 2025;12(3):499–504 innervation of the knee: an anatomic study. Reg Anesth Pain Med. 2016;41(3):321–7.
- Kolli S, Malik MF. The adductor canal block: A clinical review. Curr Anesthesiol Rep. 2019;9:291–4.
- Singh SK, Roy R, Agarwal G, Pradhan C. Peripheral nerve stimulator (PNS) guided adductor canal block: A novel approach to regional analgesia technique. Anaesth Pain Intensive Care. 2017;21(3):340–3
- Jaeger P, Nielsen ZJ, Henningsen MH, Hilsted KL, Mathiesen O, Dahl JB. Adductor canal block versus femoral nerve block and quadriceps strength: a randomized, double-blind, placebo- controlled, crossover study in healthy volunteers. Anesthesiology. 2013;118(2):409–15.
- Kwofie MK, Shastri UD, Gadsden JC, Sinha SK, Abrams JH, Xu D, et al. The effects of ultrasound-guided adductor canal block versus femoral nerve block on quadriceps strength and fall risk: a blinded, randomized trial of volunteers. Reg Anesth Pain Med. 2013;38(4):321–5.
How to Cite This Article
Vancouver
K PGRS, Kumar KRV, Muhammed A. A new two in one approach to ultrasound guided anterior sciatic and adductor canal block for below knee surgeries [Internet]. Indian J Clin Anaesth. 2025 [cited 2025 Oct 02];12(3):499-504. Available from: https://doi.org/10.18231/j.ijca.2025.077
APA
K, P. G. R. S., Kumar, K. R. V., Muhammed, A. (2025). A new two in one approach to ultrasound guided anterior sciatic and adductor canal block for below knee surgeries. Indian J Clin Anaesth, 12(3), 499-504. https://doi.org/10.18231/j.ijca.2025.077
MLA
K, Prashanth Gowtham Raj S, Kumar, Kaggathi Ramesh Vasantha, Muhammed, Ashiq. "A new two in one approach to ultrasound guided anterior sciatic and adductor canal block for below knee surgeries." Indian J Clin Anaesth, vol. 12, no. 3, 2025, pp. 499-504. https://doi.org/10.18231/j.ijca.2025.077
Chicago
K, P. G. R. S., Kumar, K. R. V., Muhammed, A.. "A new two in one approach to ultrasound guided anterior sciatic and adductor canal block for below knee surgeries." Indian J Clin Anaesth 12, no. 3 (2025): 499-504. https://doi.org/10.18231/j.ijca.2025.077