Regional

Question 1

1. How do you perform an adductor canal block
2. Why is it used preferably over femoral nerve block for TKR

Answer 1

1. Middle of thigh, medial side, locate femoral artery, approaching lateral to medial with USS transverse (in plane approach)
   See boat of the sartorius muscle. Pass through the fascia plane to lie 9 o’clock to the femoral artery, aspirate & inject moving the tissue away from the saphenous nerve revealing the adductor canal. Confirmation by scan in proximally & distally to see the spread along the adductor canal (& saphenous nerve likely to be most easily visualised)
2. Adductor canal blocks the saphenous nerve and branches of the femoral nerve. Used in TKR for reducing pain post op whilst preserving quadriceps function to aid with early mobilisation post op (as opposed to femoral nerve block which will lose motor function)

Question 2

Why block lateral cutaneous nerve during THR

Answer 2

Lateral cutaneous nerve supplies lateral thigh where classic incision is made for THR

Question 3

what is the incidence of local anaesthetic systemic toxicity during nerve blocks?

Answer 3

1.8 per 1000 nerve blocks.
it is generally lower in academic centres due to better training and adherence to safety protocols