The Korean Journal of Pain

The Korean Pain Society (대한통증학회)
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New insight into the vasto-adductor membrane for safer adductor canal blockade

  • Yanguk Heo (Department of Anatomy, Wonkwang University School of Medicine) ;
  • Miyoung Yang (Department of Anatomy, Wonkwang University School of Medicine) ;
  • Sung Min Nam (Department of Anatomy, Wonkwang University School of Medicine) ;
  • Hyun Seung Lee (Department of Anesthesiology and Pain Medicine, Wonkwang University School of Medicine, Wonkwang University Hospital) ;
  • Yeon-Dong Kim (Jesaeng-Euise Clinical Anatomy Center, Wonkwang University School of Medicine) ;
  • Hyung-Sun Won (Department of Anatomy, Wonkwang University School of Medicine)
  • Received : 2023.10.19
  • Accepted : 2023.12.16
  • Published : 2024.04.01
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Abstract

Background: This study aimed to identify exact anatomical landmarks and ideal injection volumes for safe adductor canal blocks (ACB). Methods: Fifty thighs from 25 embalmed adult Korean cadavers were used. The measurement baseline was the line connecting the anterior superior iliac spine (ASIS) to the midpoint of the patellar base. All target points were measured perpendicular to the baseline. The relevant cadaveric structures were observed using ultrasound (US) and confirmed in living individuals. US-guided dye injection was performed to determine the ideal volume. Results: The apex of the femoral triangle was 25.3 ± 2.2 cm distal to the ASIS on the baseline and 5.3 ± 1.0 cm perpendicular to that point. The midpoint of the superior border of the vasto-adductor membrane (VAM) was 27.4 ± 2.0 cm distal to the ASIS on the baseline and 5.0 ± 1.1 cm perpendicular to that point. The VAM had a trapezoidal shape and was connected as an aponeurosis between the medial edge of the vastus medialis muscle and lateral edge of the adductor magnus muscle. The nerve to the vastus medialis penetrated the muscle proximal to the superior border of the VAM in 70% of specimens. The VAM appeared on US as a hyperechoic area connecting the vastus medialis and adductor magnus muscles between the sartorius muscle and femoral artery. Conclusions: Confirming the crucial landmark, the VAM, is beneficial when performing ACB. It is advisable to insert the needle obliquely below the superior VAM border, and a 5 mL injection is considered sufficient.

Keywords

Acknowledgement

The authors thank the body donors and their families. Without their unique donations, it would have been impossible for us to complete this study.

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