If you are trying to cover a total knee replacement with a DUAL SUBSARTORIAL block, early on you state that “10-20 ml (in the proximal adductor canal) CAN spread through the adductor hiatus at the distal end of the adductor canal to cover the popliteal plexus” but later you say that the DUAL bock should be done by performing the distal femoral triangle block THEN “inject 5-10 ml” 2 cm distal to the apex of the femoral triangle. What’s the CORRECT volume at each site when conducting a DUAL SUB SARTORIAL block?
At 15:40 you describe the technique for a modified 4 in 1 block as utilizing a nerve stimulator to locate and surround the NVM. But if the motor component of NVM left even before the vastoadductor membrane appeared, how do you expect to see a motor response to the nerve stimulator?
All those where techniques described earlier with a different anatomical concept in mind. All those changed with the present anatomical knowledge which the researchers got from cadaveric dye studies. So those old techniques are obsolete now.
Excellent explanation of anatomy. Would be better if the parts are named with initials at least, and identifying the medial and lateral sides, making our understanding easier & better.
Excellent explanation. Although a single injection (20 ml) in the distal adductor canal causes the drug to travel distaly of course but proximaly too, even upto the proximal femoral triangle. Then covering NVM using PNS in the same area confers excellent post op analgesia. I'm a fan of the modified 4 in 1 😅
Sir one silly doubt you said modified 4 in 1 blocks saphaneous nerve at 16.20min you're saying modified 4 in 1 with seperate saphenous nerve block for Anaesthesia of entire leg?? Why seperate required as saphaneous nerve already covered in modified 4 in 1??
It was named 4 in 1 thinking all the 4 nerves are blocked. But later it was found that those 4 are not fully blocked especially saphenous nerve. As described in anatomy, it was shown that saphenous nerve leaves the adductor canal in the proximal part and it will not get blocked of injecting in the distal canal portion. The author of the block named it as 4 in 1 block, but now it should be renamed.
Hi. Thank you very much for the excellent video. I have a question or perhaps some confusion over the final chapter of the video. You have clearly mentioned distal femoral triangle block is able to provide most of the analgesia of the knee since it can target the saphenous nerve, nerve to vastus medialis and also subsartorial plexus-but why in the picture of the final chapter you labelled that distal FT block can only cover the superficial-medial side of the knee? 😅
First of all thank you sir for watching the video. What you've said is correct. All those nerves will cover the major medial side of knee. But that won't be sufficient for excellent analgesia. As the popliteal sciatic components will be spared. Hope I'm clear.
