Two broken pieces make a whole: adductor canal block

Total knee arthroplasty (TKA) is expounded to intense postoperative pain with a desire for early ambulation and reduce postoperative complications. Adductor canal blockade (ACB) blocks primarily the pain sensation while preserving the quadriceps strength facilitating early rehabilitation after knee surgery. ACB has been gaining popularity over femoral nerve block (FNB), continuous epidural analgesia (CEA), and psoas compartment block (PCB). Studies show that use of ultrasound alone reduced the possibilities of vascular and multiple skin punctures. Though there's emerging evidence proving the efficacy of ACB, there's limited literature on safe use of continuous ACB catheters. We report 2 cases of catheter fracture with USG guided ACB employed in TKA.

Ultrasound guided psoas compartment block and sciatic nerve block for revision arthroplasty of the knee performed two times in a patient with ankylosing spondylitis

Anesthetic management including endotracheal intubation and neuroaxial blocks is challenging in patients with ankylosing spondylitis because of the stifness of vertebral joints. Peripheral blocks in these patients may be helpful although it is not common. A 56 year-old male patient with ankylosing spondylitis having the history of total knee arthroplasty and difficult airway management was operated for the contracted knee joint prosthesis. Anteromedialisation of tuberositas tibia was performed with combination of ultrasound guided psoas compartment block (PCB) and sciatic nevre block (SNB), and repeated forty days later because of the displacement of the osteotomy site. We conclude that PCB together with SNB may be performed for knee surgery in patients with severe ankylosing spondylitis. Bangladesh Journal of Medical Science Vol.19(4) 2020 p.772-774