Re-defining the anatomical structures for blocking the nerves in adductor canal and sciatic nerve through the same injection site: an anatomical study

• Published in: Surgical and radiologic anatomy (English ed.) Vol. 40; no. 11; pp. 1267 - 1274
• Main Authors: Kendir, S., Torun, Bilge İpek, Akkaya, T., Comert, A., Tuccar, E., Tekdemir, I.
• Format: Journal Article
• Language: English
• Published: Paris Springer Paris 01.11.2018; Springer Nature B.V
• Subjects: Aged; Aged, 80 and over; Anatomic Landmarks; Anatomy; Cadaver; Cadavers; Dissection; Fascia; Female; Femoral Nerve - anatomy & histology; Femur; Humans; Imaging; Injection; Knee; Knee Joint - innervation; Latex; Male; Medicine; Medicine & Public Health; Middle Aged; Nerve Block; Nerves; Obturator Nerve - anatomy & histology; Original Article; Orthopedics; Pilot Projects; Radiology; Sciatic nerve; Sciatic Nerve - anatomy & histology; Surgery; Testing; Thigh - innervation; Adductor canal; Obturator nerve; Medial femoral cutaneous nerve; Sciatic nerve; Saphenous nerve
• ISSN: 0930-1038; 1279-8517
• DOI: 10.1007/s00276-018-2094-1

Purpose The aim of this study is to re-define the anatomical structures which are important for blocking the sciatic nerve and the nerves within the adductor canal which innervate the knee joint through the same injection site. We also aimed to investigate the spread of the anesthetic toward the areas in which the mentioned nerves lie on cadavers. Methods This study was performed on 16 lower extremities of formaldehyde-embalmed eight adult cadavers. The anatomy of adductor canal, courses of the nerves within the canal and the relationships of the saphenous, medial femoral cutaneous, medial retinacular, posterior branch of the obturator and sciatic nerves with each other and with the fascial compartments were investigated. Transverse sections that crossed the superior border of vastoadductor membrane were taken to reach the sciatic nerve in the shortest way. Colored latex was injected to demonstrate the anesthetic blockage of the targeted nerves. The structures along the needle’s way were investigated. Results The saphenous, medial femoral cutaneous and at its distal part posterior branch of the obturator nerve were colored with latex within the adductor canal. The nerve to vastus medialis (in other words, the medial retinacular nerve) lay beneath the fascia of vastus medialis and did not enter the adductor canal. There was a fascial plane which did not allow the passage of colored latex toward the sciatic nerve. To traverse this fascial structure, it was found out to be necessary to insert the needle perpendicular to both the vertical and transverse axes of the thigh and then advance it along 2/3 of diameter of the thigh. Thus, the colored latex was observed to fill the compartment where the sciatic nerve lay within. Conclusions Blocking the sciatic nerve and the nerves within the adductor canal which innervate the knee joint through the same injection site seems anatomically possible without injuring any neurovascular structures.