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Saphenous Nerve Block
Kimberly Ting, MD
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KEY FACTS

  • Terminology

    • Preprocedure

      • Procedure

        • Post Procedure

          • Outcomes

            TERMINOLOGY

            • Abbreviations

              • Interspace between popliteal artery and capsule of posterior knee (iPACK)
            • Synonyms

              • Adductor canal = subsartorial canal = Hunter canal
            • Definitions

              • Saphenous nerve
                • Consists of L2, L3
                • Largest cutaneous branch of femoral nerve
              • Saphenous nerve block can be performed at different levels as nerve courses in lower extremity from inguinal area to foot
                • At level of thigh
                  • Perifemoral (femoral block)
                  • Subsartorial (adductor canal block)
                  • Transarterial (in femoral canal)
                  • Medial femoral condyle
                  • Below-knee field block
                • At lever of leg
                  • Paravenous (at any level in leg)
                    • Can be performed at level of tibial tuberosity
                  • Medial malleolus
              • Adductor canal block: Targets saphenous nerve
                • Adductor canal borders
                  • Medially: Sartorius
                  • Anterolaterally: Vastus medialis
                  • Posteriorly: Adductor magnus and adductor longus
              • Paravenous saphenous nerve block
                • Targets saphenous nerve below knee lateral to saphenous vein
                  • Renders sensory analgesia to medial leg anteriorly and medial leg posteriorly in areas below block
                  • Saphenous nerve courses down leg along side saphenous vein posteriorly on either side

            PREPROCEDURE

            • Indications

              • Contraindications

                • Preprocedure Imaging

                  • Getting Started

                    PROCEDURE

                    • Patient Position/Location

                      • Procedure Steps

                        • Alternative Procedures/Therapies

                          POST PROCEDURE

                          • Expected Outcome

                            • Things To Do

                              • Things To Avoid

                                OUTCOMES

                                • Complications

                                  Selected References

                                  1. Kandarian BS et al: Updates on multimodal analgesia and regional anesthesia for total knee arthroplasty patients. Best Pract Res Clin Anaesthesiol. 33(1):111-23, 2019
                                  2. Kandarian B et al: Implementation of the IPACK (infiltration between the popliteal artery and capsule of the knee) block into a multimodal analgesic pathway for total knee replacement. Korean J Anesthesiol. 72(3):238-44, 2019
                                  3. Tran J et al: Evaluation of the iPACK block injectate spread: a cadaveric study. Reg Anesth Pain Med. ePub, 2019
                                  4. De Mey JC et al: A paravenous approach for the saphenous nerve block. Reg Anesth Pain Med. 26(6):504-6, 2001
                                  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

                                              • Interspace between popliteal artery and capsule of posterior knee (iPACK)
                                            • Synonyms

                                              • Adductor canal = subsartorial canal = Hunter canal
                                            • Definitions

                                              • Saphenous nerve
                                                • Consists of L2, L3
                                                • Largest cutaneous branch of femoral nerve
                                              • Saphenous nerve block can be performed at different levels as nerve courses in lower extremity from inguinal area to foot
                                                • At level of thigh
                                                  • Perifemoral (femoral block)
                                                  • Subsartorial (adductor canal block)
                                                  • Transarterial (in femoral canal)
                                                  • Medial femoral condyle
                                                  • Below-knee field block
                                                • At lever of leg
                                                  • Paravenous (at any level in leg)
                                                    • Can be performed at level of tibial tuberosity
                                                  • Medial malleolus
                                              • Adductor canal block: Targets saphenous nerve
                                                • Adductor canal borders
                                                  • Medially: Sartorius
                                                  • Anterolaterally: Vastus medialis
                                                  • Posteriorly: Adductor magnus and adductor longus
                                              • Paravenous saphenous nerve block
                                                • Targets saphenous nerve below knee lateral to saphenous vein
                                                  • Renders sensory analgesia to medial leg anteriorly and medial leg posteriorly in areas below block
                                                  • Saphenous nerve courses down leg along side saphenous vein posteriorly on either side

                                            PREPROCEDURE

                                            • Indications

                                              • Contraindications

                                                • Preprocedure Imaging

                                                  • Getting Started

                                                    PROCEDURE

                                                    • Patient Position/Location

                                                      • Procedure Steps

                                                        • Alternative Procedures/Therapies

                                                          POST PROCEDURE

                                                          • Expected Outcome

                                                            • Things To Do

                                                              • Things To Avoid

                                                                OUTCOMES

                                                                • Complications

                                                                  Selected References

                                                                  1. Kandarian BS et al: Updates on multimodal analgesia and regional anesthesia for total knee arthroplasty patients. Best Pract Res Clin Anaesthesiol. 33(1):111-23, 2019
                                                                  2. Kandarian B et al: Implementation of the IPACK (infiltration between the popliteal artery and capsule of the knee) block into a multimodal analgesic pathway for total knee replacement. Korean J Anesthesiol. 72(3):238-44, 2019
                                                                  3. Tran J et al: Evaluation of the iPACK block injectate spread: a cadaveric study. Reg Anesth Pain Med. ePub, 2019
                                                                  4. De Mey JC et al: A paravenous approach for the saphenous nerve block. Reg Anesth Pain Med. 26(6):504-6, 2001