Innervation of the Knee & Regional Anaesthesia

This talk was delivered by Dr Amit Pawa at the World Congress in Regional Anaesthesia in Paris, September 2023.
Here Dr Pawa discusses the Innervation of the Knee and introduces the concepts of Motor-Sparing Knee Blocks

[@ChingLiAAA]

Thank you for your sharing! It’s easy to understand these complex nerves through your video👍

[@DrAmitPawa]

My pleasure! - so happy you found this useful

[@danielescossia3906]

Simply a perfect presentation, as always! Thank you so much

[@DrAmitPawa]

Wow! Such a lovely comment. Thanks so much. Please do share the link with those you think will benefit from it

[@user-ol4so3xw3q]

Thank you for your helpful videos and podcasts. A minor technical point: I'm not an anatomist but I notice that the femoral triangle depicted at 6:03 has its apex on the lateral and not medial border of adductor longus and therefore does not coincide with the level of the 'prayer sign'. It seems to be commonly drawn this way on the web but I'm not sure it is correct :)

[@DrAmitPawa]

Dear James Thanks for your extremely kindly worded comment. On review you are absolutely correct! I will endeavour to correct this in all future talks and will aim to edit this video here, or if not, at least record a new section as a separate video with correct labelling and a shout out to you. I am very grateful for the polite manner in which you pointed out my error. Please accept my apologies

[@user-ol4so3xw3q]

I wouldn’t have said anything but your work is such high standard that it seemed a shame for the video to have this minor blip & my gut feeling was that you’d want it to be correct. No need to credit me though & keep up the good work. 🙂

[@ntubatr]

I really enjoyed this presentation! It is simple and comprehensive thank you Amit!!

[@DrAmitPawa]

Thank You So Much! 🙏🏽🙏🏽

[@DSmith-xf5xi]

Thanks Amit for a great lecture and video. Does getting your needle above the artery in your adductor canal/femoral triangle block allow medial spread of LA to include subsartorial plexus, and if so, what benefit does this have in knee analgesia if any? Thank you!

[@DrAmitPawa]

Thanks so much for watching and for your question. My aim for getting above the artery, and seeing the “wink” is to make sure that I am truly deep to the vastoadductor membrane and in the right space. I hope that by getting the needle above the artery and getting medial spread I may take out the subsartorial plexus which I believe will enhance the quality of the block - especially as in reality I may be using slightly lower volumes than others.

[@relikz789]

Would you hit all the genicular nerves alongside the popliteal plexus with less injections using a sciatic popliteal, realizing your also less motor sparing to the lower leg - thought was to perform the adductor canal at the apex of the femoral triangle and then hit the AFCN branch on the way out and then a sciatic popliteal to get large coverage with only 2 needle insertions?

[@DrAmitPawa]

Great question! Some folks are doing isolated tibial nerve block to achieve this. I have no experience however - but it’s a great shout!

[@ntubatr]

I've been having great luck with ACB with NVM, an IPACK and using 10ml of volume for the NVI in an out of plane approach.I think the larger volume gets both superior geniculars.@@DrAmitPawa

[@simoceci]

Awesome, but what about sistemic medications? Can you explain clearly what to use ? ( nsaid, opioids, tylenol) and what to do After the 24 hs when the block wears off? Thanks

[@DrAmitPawa]

Thank you. That was outside the remit of this talk. We use regular paracetamol, Ibuprofen (with PPI COVER), and regular immediate release morphine for 48-72 hours. Then we step down to as required morphine oral solution for another few days, and a weak opioid like dihydrocodeine. We are in the process of making a protocol for this.

[@simoceci]

Thanks Amit you are the best

[@DrAmitPawa]

@@simocecithanks - not sure I deserve that!