Duuuuude! This is the best RA channel on RU-vid by far! You're amazing please keep making them you are revolutionizing my RA practice in a hosptial where it is not done much so I have to figure it out on my own to some extent. Thank you thank you thank you!
What’re your thoughts on the motor component of the NVM? Does it increase fall risk in your obese or elderly population? Do they need that Vastus Medialis for safe ambulation?
This is my question exactly…. Would love clarification on that. That nerve coverage has to increase the incidence of quad weakness for total knees in older petite females especially
Hey Dude, from 3:51 min, the picture on US scan is marked wrongly: medial should be lateral and vice versa. Vastus Medialis is located on the medial side on the lower thigh but looking at your US picture it appears to be on the lateral side.
Any chance you could make a how-to video on using peripheral nerve stimulator for blocks, for trainees/residents? Your other videos on nerve stimulation don't really cover how to actually use the technique. Great video as always!
When I started out learning regional anesthesia, the only ultrasound machine I had available was 15 years old at that point, so the probes were worn out and visibility abysmal. I purposefully approached the adductor canal at a step angle to avoid the NVM and the redirected the needle laterally of the membrane and deposited local there. Seemed to work with no injury to NVM. Learning about NFCA forced me to revise my approach. 😊
You make excellent videos and I am a huge fan of your content. I have been doing the total knee block for awhile now and am getting great results. During one of my long knee replacements, I had too much time on my hands and figured out a potentially great name for this 8 injection technique. As it is magic, it could be named the MAGiiC Block for: nerve to vastus Medials, Adductor canal, Geniculars, nerve to vastus Intermedius, iPACK, and Cuties(for AFCN).
The well researched published articles on Dual Sub-sartorial Block [DSB] would give excellent clarity on the anatomical intricacies applicable here and exact differences btw a FT block & AC block
Great video. FYI your reference to last of the 3 videos/nerve block for superior postop pain for total knee arthroplasty doesn’t appear at end of the video? Are you referring to the AFCNs?
You'r videos are always packed with both the fundamental knowledge, and the finer details! I'd like to ask about nerve blocks in the context of reduction of an ankle fracture, in the ED, which blocks would you go for? Many thanks in advance!
This has one of the best ultrasound/tissue diagram I've ever seen! I'm speaking on applied anatomy for vascular access. Do you mind if I use a section of it for a presentation?
I used to tell trainees that there are two approaches to adductor canal with regard to where you want your needle to be when injecting. (This is in a setting where we just want saphenous. We rarely do knees) 1) I usually place my needle just supra lateral to artery close to the s nerve. 2) Jeff Gadsen directs his needle through sartorious & places his needle just supramedial to the artery thus ensuring that he won’t hit the artery. and then when he sees the artery pushed down by the local he knows it’s in the right compartment and not intramuscular. Apologies, if I have been misrepresenting your approach.
Typically we don't ablate these at the mid-thigh. The infra-patellar branch of the saphenous is often ablated (or treated with cryo-analgesia) on the medial side of the knee joint. I'd be concerned about ablating the nerve to vastus medialis...while it doesn't seem to contribute much to gross motor power in postop patients for a few days, I wouldn't want to knock it out for several months. Thanks for watching!
Jeff! Great video as always! I grimaced as that horizontal needle went through the membrane towards saphenous nerve. Looked like it was going straight for the artery!
