دورية أكاديمية
Ultrasound-guided adductor canal block: a cadaver study investigating the effect of a thigh tourniquet.
| العنوان: | Ultrasound-guided adductor canal block: a cadaver study investigating the effect of a thigh tourniquet. |
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| المؤلفون: | Nair A; School of Medicine, Glasgow, UK., Dolan J; Department of Anaesthesia, Glasgow, UK. Electronic address: johndolan@nhs.net., Tanner KE; School of Engineering, Glasgow, UK., Kerr CM; School of Engineering, Glasgow, UK., Jones B; Department of Orthopaedics, Glasgow Royal Infirmary, Glasgow, UK., Pollock PJ; School of Veterinary Medicine, University of Glasgow, Glasgow, UK., Kellett CF; School of Medicine, Glasgow, UK. |
| المصدر: | British journal of anaesthesia [Br J Anaesth] 2018 Oct; Vol. 121 (4), pp. 890-898. Date of Electronic Publication: 2018 Jun 18. |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Elsevier Country of Publication: England NLM ID: 0372541 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1471-6771 (Electronic) Linking ISSN: 00070912 NLM ISO Abbreviation: Br J Anaesth Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: 2018- : [London] : Elsevier Original Publication: London, Eng. [etc.] |
| مواضيع طبية MeSH: | Tourniquets*, Nerve Block/*methods , Thigh/*diagnostic imaging , Ultrasonography, Interventional/*methods, Aged ; Aged, 80 and over ; Anesthetics, Local/pharmacokinetics ; Cadaver ; Contrast Media ; Female ; Humans ; Image Processing, Computer-Assisted ; Iohexol ; Male ; X-Rays |
| مستخلص: | Background: Placement of local anaesthetic within the adductor canal using ultrasonography is an alternative to femoral nerve blocks for postoperative pain relief after knee joint replacement surgery. However, the effect of an inflated thigh tourniquet on the distribution of local anaesthetic within the adductor canal is unknown. The aim of this cadaveric study was to compare the distribution of radio-opaque dye within the adductor canal in the presence or absence of an inflated thigh tourniquet. Methods: Bilateral ultrasound-guided adductor canal blocks were performed on the thawed lower limbs of five fresh frozen human cadavers. The left and right lower cadaver limbs were randomised to receive or not receive a thigh tourniquet inflated to 300 mm Hg for 1 h. X-rays with iohexol radio-opaque dye were obtained in four views, and fiducial markers inserted as reference points. Virtual editing technology was used to recreate outlines representing the distribution of the radio-opaque dye and superimpose these on anatomical images. Results: Radio-opaque dye was distributed on the medial aspect of the thighs with entire and well circumscribed margins. The majority of the radio-opaque dye was confined within the adductor canal. Superior-inferior dye distribution was 315 mm [95% confidence intervals (CI) 289-342] and 264 mm (95% CI 239-289) in the presence and absence of an inflated thigh tourniquet, respectively (diff 95% CI -80.46 to -22.22, P=0.0081). Image analysis using the recreated radio-opaque outlines suggested that the most proximal point of the radio-opaque dye was 100 mm (95% CI 82-117) or 117 mm (95% CI 62-171) below the inguinal ligament in the presence and absence of an inflated thigh tourniquet, respectively (diff 95% CI -38 to 72, P=0.456). Conclusions: Application and inflation of thigh tourniquets significantly increased the combined superior-inferior dye distribution within the adductor canal of cadaveric limbs. There was insufficient evidence to suggest significant proximal spread of 25 ml of local anaesthetic to involve the motor branches of the femoral nerve. In some patients, the local anaesthetic may reach the popliteal fossa in close approximation to the sciatic nerve. (Copyright © 2018 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.) |
| فهرسة مساهمة: | Keywords: adductor canal; anesthesia, regional; arthroplasty; knee; nerve block; radio-opaque dye; ultrasound-guided regional anesthesia |
| المشرفين على المادة: | 0 (Anesthetics, Local) 0 (Contrast Media) 4419T9MX03 (Iohexol) |
| تواريخ الأحداث: | Date Created: 20180922 Date Completed: 20190122 Latest Revision: 20190122 |
| رمز التحديث: | 20221213 |
| DOI: | 10.1016/j.bja.2018.04.044 |
| PMID: | 30236251 |
| قاعدة البيانات: | MEDLINE |
| تدمد: | 1471-6771 |
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| DOI: | 10.1016/j.bja.2018.04.044 |