Adductor Canal Block Ultrasound Anatomy in Volunteers

Adductor Canal Block Clinical Trial

Official title:

Determining The Location and Ultrasound Anatomy of Two Previously Described Adductor Canal Block Approaches in Volunteers.

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT03008564
• Other study ID #: 201612345
• Status: Completed
• Phase: N/A
• First received: December 28, 2016
• Last updated: December 5, 2017
• Start date: May 1, 2017
• Est. completion date: June 16, 2017

Study information

• Verified date: November 2017
• Source: University of Iowa
• Contact: n/a
• Is FDA regulated: No
• Study type: Observational

Clinical Trial Summary

There has been dispute about the location at which the adductor canal block should be performed (3-6). Two Common approaches have been used for ultrasound guided adductor canal blocks with the 'point of entry' being:

1. Point A: midway point between the ASIS and base of patella

2. Point B: Point which is 2-3 cm proximal to the site where the femoral artery becomes the popliteal artery as it traverses away from the sartorius muscle towards the femur at the adductor hiatus (2)

We want to determine ultrasound anatomy in healthy volunteers by:

1. Measuring the distance between Point A and Point B

2. Studying the ultrasound anatomy at Point A and B - Determine their location with respect to the adductor canal and femoral triangle.

This will allow us to determine which is the best site for performing an adductor canal block

Description:

It is important to answer the primary question because of the variable length of the adductor canal and we would like to determine the optimal position to perform the adductor canal block.

The adductor canal typically contains the saphenous nerve, nerve to vastus medialis muscle and on occasion, the obturator nerve (1). The roof of adductor canal is the vasto-adductor membrane and its length is reported to range from 5.5 cm to 15 cm with a mean of 7.6 cm2 and would suggest the length of the AC is variable. We would like to determine the length of the AC with the use of ultrasound. The AC would be determined to begin at the apex of the femoral triangle and end just proximal to the adductor hiatus. The length and location of the AC would be important to characterize as the volume of local anesthetic used and associated quadriceps weakness could be of significance in a shorter AC.

There has been dispute about the location at which the adductor canal block should be performed (3-6). Point A has been disputed to be within the femoral triangle and would therefore be a femoral nerve block as suggested by a small body of evidence (4-5). Clinically, it is unclear if there is a difference between quadriceps muscle weakness between the two approaches although it could be hypothesized placing a block at point A would lead to more quadriceps muscle weakness. With information gathered from this study, we plan to perform a clinical study by performing the nerve blocks at these two points with different volumes of local anesthetic and compare the amount analgesia and motor weakness between the two different approaches.

60 Volunteers (30 male and 30 female) aged between 18 to 75 years with a body mass index of 18 to 35 kg/m2 will be included in this study. Volunteers with previous surgery or deformities of the lower extremity will be excluded from the study

This is an observational study without a control group. Several reference points will be marked by anatomical landmarks and/or ultrasound:

A. the anterior superior iliac spine (landmark); B. the base of the patella (landmark); C. apex of femoral triangle (ultrasound); and D. distal most portion of adductor canal (Point B described earlier; ultrasound).

The primary outcome measure we are looking at is the distance between Point A and Point B.

We also plan to measure the distance (in centimeters) from:

1. Base of patella to Point A

2. Base of patella to Point B

3. Apex of the femoral triangle

Recruitment information / eligibility

• Status: Completed
• Enrollment: 60
• Est. completion date: June 16, 2017
• Est. primary completion date: June 16, 2017
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: All
• Age group: 18 Years to 75 Years

Eligibility

Inclusion Criteria:

• age 18-75 years, body mass index 18-35 kg/m2

Exclusion Criteria:

• no previous surgery or complaints from the lower extremity region

Related Conditions & MeSH terms

• Adductor Canal Block
• Postop Analgesia for Knee

Intervention

Other:
• Ultrasound scanning of the lower limb in volunteers
Several reference points will be marked by anatomical landmarks and/or ultrasound: the anterior superior iliac spine; base of patella; apex of the femoral triangle A measuring tape will be used to measure the anterior superior iliac spine (landmark); the base of the patella (landmark); apex of femoral triangle (ultrasound); and distal most portion of adductor canal (Point B described earlier; ultrasound). We will then measure the ASIS to: 1) base of patella; 2) apex of femoral triangle; and 3) Point B. We will repeat the same procedure on the opposite leg. Once complete, the volunteer will be allowed to dress and leave. The procedure should take approximately 10-20 minutes for each volunteer. The following things will be recorded for each subject: Age Gender Weight Height BMI Distance of ASIS to base of patella Distance of Point A to base of patella Distance of Point B to base of patella Distance of apex of femoral triangle to base of patella

Locations

Country	Name	City	State
United States	University Of Iowa Hospitals and Clinics	Iowa City	Iowa

Sponsors (1)

Lead Sponsor	Collaborator
University of Iowa

Country where clinical trial is conducted

United States, 

References & Publications (6)

Bendtsen TF, Moriggl B, Chan V, Børglum J. Basic Topography of the Saphenous Nerve in the Femoral Triangle and the Adductor Canal. Reg Anesth Pain Med. 2015 Jul-Aug;40(4):391-2. doi: 10.1097/AAP.0000000000000261. — View Citation

Bendtsen TF, Moriggl B, Chan V, Pedersen EM, Børglum J. Defining adductor canal block. Reg Anesth Pain Med. 2014 May-Jun;39(3):253-4. doi: 10.1097/AAP.0000000000000052. — View Citation

Bendtsen TF, Moriggl B, Chan V, Pedersen EM, Børglum J. Redefining the adductor canal block. Reg Anesth Pain Med. 2014 Sep-Oct;39(5):442-3. doi: 10.1097/AAP.0000000000000119. — View Citation

Jæger P, Zaric D, Fomsgaard JS, Hilsted KL, Bjerregaard J, Gyrn J, Mathiesen O, Larsen TK, Dahl JB. Adductor canal block versus femoral nerve block for analgesia after total knee arthroplasty: a randomized, double-blind study. Reg Anesth Pain Med. 2013 Nov-Dec;38(6):526-32. doi: 10.1097/AAP.0000000000000015. — View Citation

Manickam B, Perlas A, Duggan E, Brull R, Chan VW, Ramlogan R. Feasibility and efficacy of ultrasound-guided block of the saphenous nerve in the adductor canal. Reg Anesth Pain Med. 2009 Nov-Dec;34(6):578-80. — View Citation

Tubbs RS, Loukas M, Shoja MM, Apaydin N, Oakes WJ, Salter EG. Anatomy and potential clinical significance of the vastoadductor membrane. Surg Radiol Anat. 2007 Oct;29(7):569-73. Epub 2007 Jul 7. — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Measurement 1	The distance in cm between Point A and Point B	One time assessment done during Ultrasound scanning of the lower extremity
Secondary	Measurement 2	The distance in cm between Point A and base of patella	One time assessment done during Ultrasound scanning of the lower extremity
Secondary	Measurement 3	The distance in cm between Point B and base of patella	One time assessment done during Ultrasound scanning of the lower extremity
Secondary	Measurement 4	The distance in cm between Apex of femoral triangle and base of patella	One time assessment done during Ultrasound scanning of the lower extremity