Adductor Canal Block Ultrasound Anatomy in Volunteers

NCT ID: NCT03008564

Last Updated: 2017-12-07

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Total Enrollment

60 participants

Study Classification

OBSERVATIONAL

Study Start Date

2017-05-01

Study Completion Date

2017-06-16

Brief Summary

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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

Detailed Description

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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

Conditions

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Adductor Canal Block Postop Analgesia for Knee

Study Design

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Observational Model Type

CASE_ONLY

Study Time Perspective

PROSPECTIVE

Interventions

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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

Intervention Type OTHER

Eligibility Criteria

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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
Minimum Eligible Age

18 Years

Maximum Eligible Age

75 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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University of Iowa

OTHER

Sponsor Role lead

Responsible Party

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Yatish Siddapura Ranganath

Clinical Assistant Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Amanda Yap, MBBS

Role: PRINCIPAL_INVESTIGATOR

319-356-1616

Locations

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University Of Iowa Hospitals and Clinics

Iowa City, Iowa, United States

Site Status

Countries

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United States

References

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Bendtsen TF, Moriggl B, Chan V, Pedersen EM, Borglum J. Defining adductor canal block. Reg Anesth Pain Med. 2014 May-Jun;39(3):253-4. doi: 10.1097/AAP.0000000000000052. No abstract available.

Reference Type BACKGROUND
PMID: 24747312 (View on PubMed)

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. doi: 10.1007/s00276-007-0230-4. Epub 2007 Jul 7.

Reference Type BACKGROUND
PMID: 17618402 (View on PubMed)

Jaeger 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.

Reference Type BACKGROUND
PMID: 24121608 (View on PubMed)

Bendtsen TF, Moriggl B, Chan V, Pedersen EM, Borglum J. Redefining the adductor canal block. Reg Anesth Pain Med. 2014 Sep-Oct;39(5):442-3. doi: 10.1097/AAP.0000000000000119. No abstract available.

Reference Type BACKGROUND
PMID: 25140514 (View on PubMed)

Bendtsen TF, Moriggl B, Chan V, Borglum 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. No abstract available.

Reference Type BACKGROUND
PMID: 26079358 (View on PubMed)

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. doi: 10.1097/aap.0b013e3181bfbf84.

Reference Type BACKGROUND
PMID: 19916251 (View on PubMed)

Other Identifiers

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201612345

Identifier Type: -

Identifier Source: org_study_id