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

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Abstract

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.

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Author information

Authors and Affiliations

  1. Department of Anatomy, Ankara University Faculty of Medicine, Ankara, Turkey

    S. Kendir, A. Comert, E. Tuccar & I. Tekdemir

  2. Department of Anatomy, Ankara Yildirim Beyazit University Faculty of Medicine, Bilkent, 06600, Ankara, Turkey

    Bilge İpek Torun

  3. Department of Anesthesia and Pain Unit, University of Health Sciences Diskapi Yildirim Beyazit Research and Education Hospital, Ankara, Turkey

    T. Akkaya

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  1. S. Kendir
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Contributions

SK: data collection, project development, dissections, data analysis, manuscript writing. BIT: data collection, project development, dissections, data analysis, manuscript writing. TA: project development. AC: data collection. ET: data collection. IT: management.

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Correspondence to Bilge İpek Torun.

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All the authors confirm that there is no conflict of interest either financially or non-financially.

Ethical approval

The cadavers in our department belong to unclaimed bodies and conducting scientific studies on those bodies or body parts do not require ethical approval in our university.

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Cite this article

Kendir, S., Torun, B.İ., Akkaya, T. et al. Re-defining the anatomical structures for blocking the nerves in adductor canal and sciatic nerve through the same injection site: an anatomical study. Surg Radiol Anat 40, 1267–1274 (2018). https://doi.org/10.1007/s00276-018-2094-1

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  • DOI: https://doi.org/10.1007/s00276-018-2094-1

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