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Adductor Canal Nerve Block (ACNB)
Rafael Vazquez, MD; Kimberly Ting, MD; Nicole Z. Spence, MD
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KEY FACTS

  • Terminology

    • Preprocedure

      • Procedure

        • Post Procedure

          • Outcomes

            TERMINOLOGY

            • Abbreviations

              • Adductor canal nerve block (ACNB)
            • Synonyms

              • Subsartorial canal
              • Hunter canal
            • Definitions

              • Adductor canal: Intermuscular compartment that begins proximally at apex of femoral triangle and ends distally at adductor hiatus of adductor magnus muscle
              • ACB: Blocks saphenous nerve (SN) (L 3, 4) at adductor canal
              • SN: Distal and largest cutaneous branch of femoral nerve
                • SN traverses in close proximity to vessels along its path to distal foot
                  • Alongside femoral artery (FA) above knee
                  • Alongside descending genicular artery and saphenous branch at knee
                  • Alongside great saphenous vein in lower leg and ankle
              • Adductor canal borders
                • Anteromedially: Vastoadductor membrane (deep to sartorius muscle)
                • Laterally: Vastus medialis muscle
                • Posteromedially: Adductor magnus or adductor longus muscles (depending on how proximal or distal within canal)
              • Adductor canal contents
                • FA
                • Femoral vein (FV)
                • SN
              • Nerve to vastus medialis muscle is located in separate myofascial tunnel ventral to AC
              • SN most often found lateral to FA at proximal portion of canal
                • Distally, it is found medially to FA

            PREPROCEDURE

            • Indications

              • Contraindications

                • Preprocedure Imaging

                  • Getting Started

                    PROCEDURE

                    • Patient Position/Location

                      • Equipment Preparation

                        • Procedure Steps

                          • Findings and Reporting

                            • Alternative Procedures/Therapies

                              POST PROCEDURE

                              • Expected Outcome

                                • Things To Do

                                  • Things To Avoid

                                    OUTCOMES

                                    • Problems

                                      • Complications

                                        Selected References

                                        1. Ambrosoli AL et al: Postoperative analgesia and early functional recovery after day-case anterior cruciate ligament reconstruction. a randomized trial on local anesthetic delivery methods for continuous infusion adductor canal block. Minerva Anestesiol. 85(9): 962-70, 2019
                                        2. Batistaki C et al: Ultrasound-guided saphenous nerve block for saphenous neuralgia after knee surgery: two case reports and review of literature. Indian J Orthop. 53(1):208-12, 2019
                                        3. Elkassabany NM et al: A prospective randomized open-label study of single injection versus continuous adductor canal block for postoperative analgesia after total knee arthroplasty. Bone Joint J. 101-B(3):340-7, 2019
                                        4. Kastelik J et al: Local infiltration anaesthesia versus sciatic nerve and adductor canal block for fast-track knee arthroplasty: a randomised controlled clinical trial. Eur J Anaesthesiol. 36(4):255-63, 2019
                                        5. Klement MR et al: Continuous adductor canal blockade facilitates increased home discharge and decreased opioid consumption after total knee arthroplasty. Knee. ePub, 2019
                                        6. Kim DH et al: Addition of infiltration between the popliteal artery and the capsule of the posterior knee and adductor canal block to periarticular injection enhances postoperative pain control in total knee arthroplasty: a randomized controlled trial. Anesth Analg. 129(2):526-35, 2018
                                        7. Koniuch KL et al: Case report of a massive thigh hematoma after adductor canal block in a morbidly obese woman anticoagulated with apixaban. Case Rep Anesthesiol. 2018:7653202, 2018
                                        8. Nair A et al: Ultrasound-guided adductor canal block: a cadaver study investigating the effect of a thigh tourniquet. Br J Anaesth. 121(4):890-8, 2018
                                        9. Runner RP et al: Quadriceps strength deficits after a femoral nerve block versus adductor canal block for anterior cruciate ligament reconstruction: a prospective, single-blinded, randomized trial. Orthop J Sports Med. 6(9):2325967118797990, 2018
                                        10. Tao Y et al: Median effective volume of ropivacaine 0.5% for ultrasound-guided adductor canal block. J Int Med Res. 46(10):4207-13, 2018
                                        11. Bendtsen TF et al: The optimal analgesic block for total knee arthroplasty. Reg Anesth Pain Med. 41(6):711-9, 2016
                                        12. Davis JJ et al: Adductor canal block: more than just the saphenous nerve? Reg Anesth Pain Med. 34(6):618-9, 2009
                                        13. Tubbs RS et al: Anatomy and potential clinical significance of the vastoadductor membrane. Surg Radiol Anat. 29(7):569-73, 2007
                                        14. Gray H: Anatomy: Descriptive and Surgical. 17th ed. Philadelphia: Lea and Febiger, 1908
                                        Related Anatomy
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                                        Related Differential Diagnoses
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                                        References
                                        Tables

                                        Tables

                                        KEY FACTS

                                        • Terminology

                                          • Preprocedure

                                            • Procedure

                                              • Post Procedure

                                                • Outcomes

                                                  TERMINOLOGY

                                                  • Abbreviations

                                                    • Adductor canal nerve block (ACNB)
                                                  • Synonyms

                                                    • Subsartorial canal
                                                    • Hunter canal
                                                  • Definitions

                                                    • Adductor canal: Intermuscular compartment that begins proximally at apex of femoral triangle and ends distally at adductor hiatus of adductor magnus muscle
                                                    • ACB: Blocks saphenous nerve (SN) (L 3, 4) at adductor canal
                                                    • SN: Distal and largest cutaneous branch of femoral nerve
                                                      • SN traverses in close proximity to vessels along its path to distal foot
                                                        • Alongside femoral artery (FA) above knee
                                                        • Alongside descending genicular artery and saphenous branch at knee
                                                        • Alongside great saphenous vein in lower leg and ankle
                                                    • Adductor canal borders
                                                      • Anteromedially: Vastoadductor membrane (deep to sartorius muscle)
                                                      • Laterally: Vastus medialis muscle
                                                      • Posteromedially: Adductor magnus or adductor longus muscles (depending on how proximal or distal within canal)
                                                    • Adductor canal contents
                                                      • FA
                                                      • Femoral vein (FV)
                                                      • SN
                                                    • Nerve to vastus medialis muscle is located in separate myofascial tunnel ventral to AC
                                                    • SN most often found lateral to FA at proximal portion of canal
                                                      • Distally, it is found medially to FA

                                                  PREPROCEDURE

                                                  • Indications

                                                    • Contraindications

                                                      • Preprocedure Imaging

                                                        • Getting Started

                                                          PROCEDURE

                                                          • Patient Position/Location

                                                            • Equipment Preparation

                                                              • Procedure Steps

                                                                • Findings and Reporting

                                                                  • Alternative Procedures/Therapies

                                                                    POST PROCEDURE

                                                                    • Expected Outcome

                                                                      • Things To Do

                                                                        • Things To Avoid

                                                                          OUTCOMES

                                                                          • Problems

                                                                            • Complications

                                                                              Selected References

                                                                              1. Ambrosoli AL et al: Postoperative analgesia and early functional recovery after day-case anterior cruciate ligament reconstruction. a randomized trial on local anesthetic delivery methods for continuous infusion adductor canal block. Minerva Anestesiol. 85(9): 962-70, 2019
                                                                              2. Batistaki C et al: Ultrasound-guided saphenous nerve block for saphenous neuralgia after knee surgery: two case reports and review of literature. Indian J Orthop. 53(1):208-12, 2019
                                                                              3. Elkassabany NM et al: A prospective randomized open-label study of single injection versus continuous adductor canal block for postoperative analgesia after total knee arthroplasty. Bone Joint J. 101-B(3):340-7, 2019
                                                                              4. Kastelik J et al: Local infiltration anaesthesia versus sciatic nerve and adductor canal block for fast-track knee arthroplasty: a randomised controlled clinical trial. Eur J Anaesthesiol. 36(4):255-63, 2019
                                                                              5. Klement MR et al: Continuous adductor canal blockade facilitates increased home discharge and decreased opioid consumption after total knee arthroplasty. Knee. ePub, 2019
                                                                              6. Kim DH et al: Addition of infiltration between the popliteal artery and the capsule of the posterior knee and adductor canal block to periarticular injection enhances postoperative pain control in total knee arthroplasty: a randomized controlled trial. Anesth Analg. 129(2):526-35, 2018
                                                                              7. Koniuch KL et al: Case report of a massive thigh hematoma after adductor canal block in a morbidly obese woman anticoagulated with apixaban. Case Rep Anesthesiol. 2018:7653202, 2018
                                                                              8. Nair A et al: Ultrasound-guided adductor canal block: a cadaver study investigating the effect of a thigh tourniquet. Br J Anaesth. 121(4):890-8, 2018
                                                                              9. Runner RP et al: Quadriceps strength deficits after a femoral nerve block versus adductor canal block for anterior cruciate ligament reconstruction: a prospective, single-blinded, randomized trial. Orthop J Sports Med. 6(9):2325967118797990, 2018
                                                                              10. Tao Y et al: Median effective volume of ropivacaine 0.5% for ultrasound-guided adductor canal block. J Int Med Res. 46(10):4207-13, 2018
                                                                              11. Bendtsen TF et al: The optimal analgesic block for total knee arthroplasty. Reg Anesth Pain Med. 41(6):711-9, 2016
                                                                              12. Davis JJ et al: Adductor canal block: more than just the saphenous nerve? Reg Anesth Pain Med. 34(6):618-9, 2009
                                                                              13. Tubbs RS et al: Anatomy and potential clinical significance of the vastoadductor membrane. Surg Radiol Anat. 29(7):569-73, 2007
                                                                              14. Gray H: Anatomy: Descriptive and Surgical. 17th ed. Philadelphia: Lea and Febiger, 1908