Impact of leg movement on skin-adductor canal distance: a potential cause for catheter tip displacement?
Purpose Catheter-based adductor canal blocks are an effective pain management strategy for total knee arthroplasty. Nevertheless, catheter-based techniques may fail if the tip migrates because of leg movement. This observational study used ultrasound to measure the distance from the skin to the addu...
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| Veröffentlicht in: | Canadian journal of anesthesia 2020-08, Vol.67 (8), p.936-941 |
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| creator | Tholin, Marcus Wilson, Jason Lee, Steven Tang, Raymond Sawka, Andrew Vaghadia, Himat |
| description | Purpose
Catheter-based adductor canal blocks are an effective pain management strategy for total knee arthroplasty. Nevertheless, catheter-based techniques may fail if the tip migrates because of leg movement. This observational study used ultrasound to measure the distance from the skin to the adductor canal (SAC). We tested the hypothesis that leg movements mimicking those occurring during postoperative physiotherapy change the SAC distance.
Methods
Following total knee arthroplasty under spinal anesthesia, the SAC distance was measured using ultrasound in 40 patients. The leg was passively moved into five standardized positions: neutral, neutral position with manual lateral displacement of the skin, 30° external rotation, straight leg raised to 30°, and knee and hip flexed to 90°.
Results
The mean (standard deviation) SAC distance change from the neutral position was +1.0 (0.6) cm with manual displacement, +0.3 (0.4) cm with external rotation, +0.4 (0.4) cm with straight leg raise, and +0.6 (0.5) cm with leg flexion (
P
< 0.001 for all positions). SAC distance changes did not correlate with height, body mass index, or leg circumference.
Conclusion
Passive leg movements in five standardized positions increase the SAC distance. We speculate that the altered SAC distance associated with passive leg movement may contribute to catheter tip dislodgement and adductor canal block failure.
Trial registration
www.clinicaltrials.gov
, NCT03562559; registered 19 June, 2018. |
| doi_str_mv | 10.1007/s12630-020-01693-6 |
| format | Article |
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Catheter-based adductor canal blocks are an effective pain management strategy for total knee arthroplasty. Nevertheless, catheter-based techniques may fail if the tip migrates because of leg movement. This observational study used ultrasound to measure the distance from the skin to the adductor canal (SAC). We tested the hypothesis that leg movements mimicking those occurring during postoperative physiotherapy change the SAC distance.
Methods
Following total knee arthroplasty under spinal anesthesia, the SAC distance was measured using ultrasound in 40 patients. The leg was passively moved into five standardized positions: neutral, neutral position with manual lateral displacement of the skin, 30° external rotation, straight leg raised to 30°, and knee and hip flexed to 90°.
Results
The mean (standard deviation) SAC distance change from the neutral position was +1.0 (0.6) cm with manual displacement, +0.3 (0.4) cm with external rotation, +0.4 (0.4) cm with straight leg raise, and +0.6 (0.5) cm with leg flexion (
P
< 0.001 for all positions). SAC distance changes did not correlate with height, body mass index, or leg circumference.
Conclusion
Passive leg movements in five standardized positions increase the SAC distance. We speculate that the altered SAC distance associated with passive leg movement may contribute to catheter tip dislodgement and adductor canal block failure.
Trial registration
www.clinicaltrials.gov
, NCT03562559; registered 19 June, 2018.</description><identifier>ISSN: 0832-610X</identifier><identifier>EISSN: 1496-8975</identifier><identifier>DOI: 10.1007/s12630-020-01693-6</identifier><identifier>PMID: 32385824</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>Anesthesiology ; Anesthetics, Local ; Cardiology ; Catheters ; Critical Care Medicine ; Humans ; Intensive ; Joint replacement surgery ; Joint surgery ; Leg - diagnostic imaging ; Medicine ; Medicine & Public Health ; Nerve Block ; Pain Medicine ; Pain, Postoperative ; Pediatrics ; Pneumology/Respiratory System ; Reports of Original Investigations ; Skin ; Ultrasonic imaging</subject><ispartof>Canadian journal of anesthesia, 2020-08, Vol.67 (8), p.936-941</ispartof><rights>Canadian Anesthesiologists' Society 2020</rights><rights>Canadian Anesthesiologists' Society 2020.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c419t-7b61e7b1c28121814a0972174ac63dc0b3d35403ca6993ab859dabe26e057e9d3</citedby><cites>FETCH-LOGICAL-c419t-7b61e7b1c28121814a0972174ac63dc0b3d35403ca6993ab859dabe26e057e9d3</cites><orcidid>0000-0002-1738-2514</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s12630-020-01693-6$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s12630-020-01693-6$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32385824$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Tholin, Marcus</creatorcontrib><creatorcontrib>Wilson, Jason</creatorcontrib><creatorcontrib>Lee, Steven</creatorcontrib><creatorcontrib>Tang, Raymond</creatorcontrib><creatorcontrib>Sawka, Andrew</creatorcontrib><creatorcontrib>Vaghadia, Himat</creatorcontrib><title>Impact of leg movement on skin-adductor canal distance: a potential cause for catheter tip displacement?</title><title>Canadian journal of anesthesia</title><addtitle>Can J Anesth/J Can Anesth</addtitle><addtitle>Can J Anaesth</addtitle><description>Purpose
Catheter-based adductor canal blocks are an effective pain management strategy for total knee arthroplasty. Nevertheless, catheter-based techniques may fail if the tip migrates because of leg movement. This observational study used ultrasound to measure the distance from the skin to the adductor canal (SAC). We tested the hypothesis that leg movements mimicking those occurring during postoperative physiotherapy change the SAC distance.
Methods
Following total knee arthroplasty under spinal anesthesia, the SAC distance was measured using ultrasound in 40 patients. The leg was passively moved into five standardized positions: neutral, neutral position with manual lateral displacement of the skin, 30° external rotation, straight leg raised to 30°, and knee and hip flexed to 90°.
Results
The mean (standard deviation) SAC distance change from the neutral position was +1.0 (0.6) cm with manual displacement, +0.3 (0.4) cm with external rotation, +0.4 (0.4) cm with straight leg raise, and +0.6 (0.5) cm with leg flexion (
P
< 0.001 for all positions). SAC distance changes did not correlate with height, body mass index, or leg circumference.
Conclusion
Passive leg movements in five standardized positions increase the SAC distance. We speculate that the altered SAC distance associated with passive leg movement may contribute to catheter tip dislodgement and adductor canal block failure.
Trial registration
www.clinicaltrials.gov
, NCT03562559; registered 19 June, 2018.</description><subject>Anesthesiology</subject><subject>Anesthetics, Local</subject><subject>Cardiology</subject><subject>Catheters</subject><subject>Critical Care Medicine</subject><subject>Humans</subject><subject>Intensive</subject><subject>Joint replacement surgery</subject><subject>Joint surgery</subject><subject>Leg - diagnostic imaging</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Nerve Block</subject><subject>Pain Medicine</subject><subject>Pain, Postoperative</subject><subject>Pediatrics</subject><subject>Pneumology/Respiratory System</subject><subject>Reports of Original Investigations</subject><subject>Skin</subject><subject>Ultrasonic imaging</subject><issn>0832-610X</issn><issn>1496-8975</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp9kctuFTEMhiNURA8tL8ACReqGzYCdzOTCBqGKS6VKbEDqLspkfNpp59Ykg8Tbk3NOSyUWLCzL8ec_sn_GXiO8QwD9PqFQEioQJVBZWalnbIO1VZWxujliGzBSVArh6pi9TOkWAIxqzAt2LIU0jRH1ht1cjIsPmc9bPtA1H-dfNNJU6omnu36qfNetIc-RBz_5gXd9yn4K9IF7vsy5kH15DX5NxLd7Kt9Qpshzv-zgZfBhL_jxlD3f-iHRq4d8wn5--fzj_Ft1-f3rxfmnyyrUaHOlW4WkWwzCoECDtQerBeraByW7AK3sZFODDF5ZK31rGtv5loQiaDTZTp6wtwfdJc73K6Xsxj4FGgY_0bwmJ2qABrWyoqBn_6C38xrLmjtKoJIoal0ocaBCnFOKtHVL7EcffzsEt_PBHXxwxQe398GpMvTmQXptR-r-jjwevgDyAKTSmq4pPv39H9k_P8qSfg</recordid><startdate>20200801</startdate><enddate>20200801</enddate><creator>Tholin, Marcus</creator><creator>Wilson, Jason</creator><creator>Lee, Steven</creator><creator>Tang, Raymond</creator><creator>Sawka, Andrew</creator><creator>Vaghadia, Himat</creator><general>Springer International Publishing</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8FQ</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-1738-2514</orcidid></search><sort><creationdate>20200801</creationdate><title>Impact of leg movement on skin-adductor canal distance: a potential cause for catheter tip displacement?</title><author>Tholin, Marcus ; Wilson, Jason ; Lee, Steven ; Tang, Raymond ; Sawka, Andrew ; Vaghadia, Himat</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c419t-7b61e7b1c28121814a0972174ac63dc0b3d35403ca6993ab859dabe26e057e9d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Anesthesiology</topic><topic>Anesthetics, Local</topic><topic>Cardiology</topic><topic>Catheters</topic><topic>Critical Care Medicine</topic><topic>Humans</topic><topic>Intensive</topic><topic>Joint replacement surgery</topic><topic>Joint surgery</topic><topic>Leg - diagnostic imaging</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Nerve Block</topic><topic>Pain Medicine</topic><topic>Pain, Postoperative</topic><topic>Pediatrics</topic><topic>Pneumology/Respiratory System</topic><topic>Reports of Original Investigations</topic><topic>Skin</topic><topic>Ultrasonic imaging</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Tholin, Marcus</creatorcontrib><creatorcontrib>Wilson, Jason</creatorcontrib><creatorcontrib>Lee, Steven</creatorcontrib><creatorcontrib>Tang, Raymond</creatorcontrib><creatorcontrib>Sawka, Andrew</creatorcontrib><creatorcontrib>Vaghadia, Himat</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Canadian Business & Current Affairs Database</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>Canadian journal of anesthesia</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Tholin, Marcus</au><au>Wilson, Jason</au><au>Lee, Steven</au><au>Tang, Raymond</au><au>Sawka, Andrew</au><au>Vaghadia, Himat</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of leg movement on skin-adductor canal distance: a potential cause for catheter tip displacement?</atitle><jtitle>Canadian journal of anesthesia</jtitle><stitle>Can J Anesth/J Can Anesth</stitle><addtitle>Can J Anaesth</addtitle><date>2020-08-01</date><risdate>2020</risdate><volume>67</volume><issue>8</issue><spage>936</spage><epage>941</epage><pages>936-941</pages><issn>0832-610X</issn><eissn>1496-8975</eissn><abstract>Purpose
Catheter-based adductor canal blocks are an effective pain management strategy for total knee arthroplasty. Nevertheless, catheter-based techniques may fail if the tip migrates because of leg movement. This observational study used ultrasound to measure the distance from the skin to the adductor canal (SAC). We tested the hypothesis that leg movements mimicking those occurring during postoperative physiotherapy change the SAC distance.
Methods
Following total knee arthroplasty under spinal anesthesia, the SAC distance was measured using ultrasound in 40 patients. The leg was passively moved into five standardized positions: neutral, neutral position with manual lateral displacement of the skin, 30° external rotation, straight leg raised to 30°, and knee and hip flexed to 90°.
Results
The mean (standard deviation) SAC distance change from the neutral position was +1.0 (0.6) cm with manual displacement, +0.3 (0.4) cm with external rotation, +0.4 (0.4) cm with straight leg raise, and +0.6 (0.5) cm with leg flexion (
P
< 0.001 for all positions). SAC distance changes did not correlate with height, body mass index, or leg circumference.
Conclusion
Passive leg movements in five standardized positions increase the SAC distance. We speculate that the altered SAC distance associated with passive leg movement may contribute to catheter tip dislodgement and adductor canal block failure.
Trial registration
www.clinicaltrials.gov
, NCT03562559; registered 19 June, 2018.</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>32385824</pmid><doi>10.1007/s12630-020-01693-6</doi><tpages>6</tpages><orcidid>https://orcid.org/0000-0002-1738-2514</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | Canadian journal of anesthesia, 2020-08, Vol.67 (8), p.936-941 |
| issn | 0832-610X 1496-8975 |
| language | eng |
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| source | MEDLINE; Springer Online Journals Complete |
| subjects | Anesthesiology Anesthetics, Local Cardiology Catheters Critical Care Medicine Humans Intensive Joint replacement surgery Joint surgery Leg - diagnostic imaging Medicine Medicine & Public Health Nerve Block Pain Medicine Pain, Postoperative Pediatrics Pneumology/Respiratory System Reports of Original Investigations Skin Ultrasonic imaging |
| title | Impact of leg movement on skin-adductor canal distance: a potential cause for catheter tip displacement? |
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