{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T18:27:57Z","timestamp":1768588077621,"version":"3.49.0"},"reference-count":18,"publisher":"BMJ","issue":"6","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Reg Anesth Pain Med"],"accepted":{"date-parts":[[2023,8,15]]},"published-print":{"date-parts":[[2024,6]]},"abstract":"<jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Total knee arthroplasty is associated with significant postoperative pain. Continuous adductor canal blocks via an inserted adductor canal catheter are effective analgesia interventions with the advantage of decreasing quadriceps weakness and the potential of extending the analgesic effect. The classical adductor canal catheter insertion technique may have a high likelihood of catheter dislodgement out of the canal. The interfascial plane between the sartorius muscle and femoral artery (ISAFE) approach has the potential of decreasing the adductor canal catheter migration. The purpose of this study was to evaluate the incidence of catheter dislodgment to outside the adductor canal, for ISAFE and classical approaches. We hypothesized that ISAFE approach would result in a lower dislodgment rate.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Ninety-seven patients for unilateral total knee arthroplasty were included and randomized to either ISAFE intervention group or conventional group. The primary outcome was the incidence of adductor canal catheter dislodged to outside the adductor canal, on ultrasound evaluation, 24\u2009hours after the surgery. Secondary outcomes were pain scores, opioid consumption and continuous adductor canal block related complications for the first 48 hours after surgery.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The catheters placed using ISAFE approach had a lower rate of dislodgement in comparison to the control group (18.6% vs 44.9%, respectively, p=0.01), at 24 hours after surgery; and lower pain scores for rest, on the first two postoperative days.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>ISAFE group had a significantly lower rate of dislodgement at 24 hours. The continuous adductor canal block analgesic benefit for knee arthroplasty depends on the position of the tip of the catheter inside the adductor canal.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/rapm-2023-104654","type":"journal-article","created":{"date-parts":[[2023,9,13]],"date-time":"2023-09-13T21:55:12Z","timestamp":1694642112000},"page":"423-428","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":8,"title":["Comparison of migration rates between traditional and tunneled adductor canal block catheters: a randomized controlled trial"],"prefix":"10.1136","volume":"49","clinical-trial-number":[{"clinical-trial-number":"nct05313269","registry":"10.18810\/clinical-trials-gov"}],"author":[{"given":"Yehoshua","family":"Gleicher","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9298-6118","authenticated-orcid":false,"given":"Hermann","family":"dos Santos Fernandes","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sharon","family":"Peacock","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tural","family":"Alekberli","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vitaliano","family":"Di Grazia","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Regine","family":"Estrellas","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jesse","family":"Wolfstadt","sequence":"additional","affiliation":[{"name":"Surgery, Division of Orthopaedics, Sinai Health System, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John","family":"Matelski","sequence":"additional","affiliation":[{"name":"Biostatistics Research Unit, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Naveed","family":"Siddiqui","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2023,9,13]]},"reference":[{"key":"2025101111534196000_49.6.423.1","doi-asserted-by":"crossref","first-page":"1672","DOI":"10.1016\/S0140-6736(18)32344-4","article-title":"Troelsen A et al","volume":"392","author":"Price","year":"2018","journal-title":"Knee Replacement Lancet"},{"key":"2025101111534196000_49.6.423.2","unstructured":"OECD . Oecd indicators. In: Health at a glance 2019. Paris: OECD Publishing, 2019."},{"key":"2025101111534196000_49.6.423.3","doi-asserted-by":"crossref","DOI":"10.1007\/s11916-017-0623-y","article-title":"Anesthetic and analgesic management for outpatient knee Arthroplasty","volume":"21","author":"Cullom","year":"2017","journal-title":"Curr Pain Headache Rep"},{"key":"2025101111534196000_49.6.423.4","doi-asserted-by":"crossref","first-page":"356","DOI":"10.1097\/AJP.0000000000000402","article-title":"Adductor canal block versus femoral nerve block for analgesia after total knee Arthroplasty: A systematic review and meta-analysis","volume":"33","author":"Gao","year":"2017","journal-title":"Clin J Pain"},{"key":"2025101111534196000_49.6.423.5","doi-asserted-by":"crossref","first-page":"40721","DOI":"10.1038\/srep40721","article-title":"Adductor canal block versus femoral nerve block for total knee Arthroplasty: A meta-analysis of randomized controlled trials","volume":"7","author":"Wang","year":"2017","journal-title":"Sci Rep"},{"key":"2025101111534196000_49.6.423.6","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1016\/j.jclinane.2018.06.004","article-title":"Postoperative continuous Adductor canal block for total knee Arthroplasty improves pain and functional recovery: A randomized controlled clinical trial","volume":"49","author":"Leung","year":"2018","journal-title":"J Clin Anesth"},{"key":"2025101111534196000_49.6.423.7","doi-asserted-by":"crossref","DOI":"10.1097\/MD.0000000000022762","article-title":"Continuous Adductor canal block provides better performance after total knee Arthroplasty compared with the single-shot Adductor canal block","volume":"99","author":"Yu","year":"2020","journal-title":"Medicine"},{"key":"2025101111534196000_49.6.423.8","doi-asserted-by":"publisher","DOI":"10.1136\/rapm-2019-100610"},{"key":"2025101111534196000_49.6.423.9","doi-asserted-by":"publisher","DOI":"10.1136\/rapm-2022-103756"},{"key":"2025101111534196000_49.6.423.10","doi-asserted-by":"crossref","first-page":"110571","DOI":"10.1016\/j.jclinane.2021.110571","article-title":"Inter-Fascial space between Sartorius muscle and femoral artery (ISAFE): A suggested approach for Adductor canal catheter placement","volume":"76","author":"Dos Santos Fernandes","year":"2022","journal-title":"J Clin Anesth"},{"key":"2025101111534196000_49.6.423.11","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1016\/j.bjan.2017.03.006","article-title":"The correlation among the Ramsay sedation scale, Richmond agitation sedation scale and Riker sedation agitation scale during midazolam-remifentanil sedation","volume":"67","author":"Namigar","year":"2017","journal-title":"Rev Bras Anestesiol"},{"key":"2025101111534196000_49.6.423.12","doi-asserted-by":"publisher","DOI":"10.1111\/aas.12451"},{"key":"2025101111534196000_49.6.423.13","doi-asserted-by":"crossref","first-page":"458","DOI":"10.1213\/ANE.0000000000006234","article-title":"Pro and con: how important is the exact location of Adductor Canal and femoral triangle blocks","volume":"136","author":"Woodworth","year":"2023","journal-title":"Anesth Analg"},{"key":"2025101111534196000_49.6.423.14","doi-asserted-by":"crossref","unstructured":"Gleicher Y (Josh ), Kruisselbrink R . Considerations for starting an outpatient Adductor canal catheter program. ASRANews 2022;47. doi:10.52211\/asra050122.017 Available: https:\/\/www.asra.com\/news-publications\/asra-newsletter\/may-2022","DOI":"10.52211\/asra050122.017"},{"key":"2025101111534196000_49.6.423.15","doi-asserted-by":"crossref","first-page":"468","DOI":"10.1177\/0310057X1804600507","article-title":"Does a catheter over needle system reduce infusate leak in continuous peripheral nerve blockade: A randomised controlled trial","volume":"46","author":"Edwards","year":"2018","journal-title":"Anaesth Intensive Care"},{"key":"2025101111534196000_49.6.423.16","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2019.103208"},{"key":"2025101111534196000_49.6.423.17","doi-asserted-by":"publisher","DOI":"10.1136\/rapm-2022-104303"},{"key":"2025101111534196000_49.6.423.18","doi-asserted-by":"crossref","first-page":"1","DOI":"10.21608\/ejana.2017.5709","article-title":"Subsartorial compartments and membranes in the Adductor canal:morphological, histological and immunohistochemical study","volume":"40","author":"Elazab","year":"2017","journal-title":"Egypt J Anat"}],"container-title":["Regional Anesthesia &amp; Pain Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/rapm-2023-104654","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T18:53:51Z","timestamp":1760208831000},"score":1,"resource":{"primary":{"URL":"https:\/\/rapm.bmj.com\/lookup\/doi\/10.1136\/rapm-2023-104654"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,9,13]]},"references-count":18,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2024,6,3]]},"published-print":{"date-parts":[[2024,6]]}},"alternative-id":["10.1136\/rapm-2023-104654"],"URL":"https:\/\/doi.org\/10.1136\/rapm-2023-104654","relation":{},"ISSN":["1098-7339","1532-8651"],"issn-type":[{"value":"1098-7339","type":"print"},{"value":"1532-8651","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,9,13]]}}}