Duuuuude! This is the best RA channel on UA-cam by far! You're amazing please keep making them you are revolutionizing my RA practice in a hosptial where it is not done much so I have to figure it out on my own to some extent. Thank you thank you thank you!
This is the most useful channel on UA-cam. I’ve learned some new blocks and you’re so inspiring me to learn everyday❤ thank you from Ukraine. I’ve shared this with my whole department
When I started out learning regional anesthesia, the only ultrasound machine I had available was 15 years old at that point, so the probes were worn out and visibility abysmal. I purposefully approached the adductor canal at a step angle to avoid the NVM and the redirected the needle laterally of the membrane and deposited local there. Seemed to work with no injury to NVM. Learning about NFCA forced me to revise my approach. 😊
Thank you I did it last month, it worked great, the patient only needed paracetamol and NSAIDs until he went home, it was ACL reconstruction, unfortanately we don't have nerve stimulator, but I do them under mild sedation
What’re your thoughts on the motor component of the NVM? Does it increase fall risk in your obese or elderly population? Do they need that Vastus Medialis for safe ambulation?
This is my question exactly…. Would love clarification on that. That nerve coverage has to increase the incidence of quad weakness for total knees in older petite females especially
I used to tell trainees that there are two approaches to adductor canal with regard to where you want your needle to be when injecting. (This is in a setting where we just want saphenous. We rarely do knees) 1) I usually place my needle just supra lateral to artery close to the s nerve. 2) Jeff Gadsen directs his needle through sartorious & places his needle just supramedial to the artery thus ensuring that he won’t hit the artery. and then when he sees the artery pushed down by the local he knows it’s in the right compartment and not intramuscular. Apologies, if I have been misrepresenting your approach.
You make excellent videos and I am a huge fan of your content. I have been doing the total knee block for awhile now and am getting great results. During one of my long knee replacements, I had too much time on my hands and figured out a potentially great name for this 8 injection technique. As it is magic, it could be named the MAGiiC Block for: nerve to vastus Medials, Adductor canal, Geniculars, nerve to vastus Intermedius, iPACK, and Cuties(for AFCN).
You'r videos are always packed with both the fundamental knowledge, and the finer details! I'd like to ask about nerve blocks in the context of reduction of an ankle fracture, in the ED, which blocks would you go for? Many thanks in advance!
Typically we don't ablate these at the mid-thigh. The infra-patellar branch of the saphenous is often ablated (or treated with cryo-analgesia) on the medial side of the knee joint. I'd be concerned about ablating the nerve to vastus medialis...while it doesn't seem to contribute much to gross motor power in postop patients for a few days, I wouldn't want to knock it out for several months. Thanks for watching!
Any chance you could make a how-to video on using peripheral nerve stimulator for blocks, for trainees/residents? Your other videos on nerve stimulation don't really cover how to actually use the technique. Great video as always!
What settings would you use for the nerve stimulator for the NVM part? Also when you get the NVM twitch are you then turning down the amplitude or withdrawing/redirecting the needle or any other changes to help ensure you're not intraneural? Didn't learn nerve stim during training, but would like to add this NVM blockage to my adductor blocks and want to make sure I'm not missing anything. Thanks.
The well researched published articles on Dual Sub-sartorial Block [DSB] would give excellent clarity on the anatomical intricacies applicable here and exact differences btw a FT block & AC block
Jeff! Great video as always! I grimaced as that horizontal needle went through the membrane towards saphenous nerve. Looked like it was going straight for the artery!
This has one of the best ultrasound/tissue diagram I've ever seen! I'm speaking on applied anatomy for vascular access. Do you mind if I use a section of it for a presentation?
Great video. FYI your reference to last of the 3 videos/nerve block for superior postop pain for total knee arthroplasty doesn’t appear at end of the video? Are you referring to the AFCNs?
Hey Dude, from 3:51 min, the picture on US scan is marked wrongly: medial should be lateral and vice versa. Vastus Medialis is located on the medial side on the lower thigh but looking at your US picture it appears to be on the lateral side.
Duuuuude! This is the best RA channel on UA-cam by far! You're amazing please keep making them you are revolutionizing my RA practice in a hosptial where it is not done much so I have to figure it out on my own to some extent. Thank you thank you thank you!
Dr. Gadsden, as always I appreciate you and all you do. Your videos are the absolute best and I love that you consistently create new content!
This is the most useful channel on UA-cam. I’ve learned some new blocks and you’re so inspiring me to learn everyday❤ thank you from Ukraine. I’ve shared this with my whole department
4:03 you’re whalecome! So witty! Enjoyed this lecture so much! Thank you
Thank you for providing those great videos! I learned a lot from them and frequently rewatch them to internalize every aspect, Keep up the great work!
When I started out learning regional anesthesia, the only ultrasound machine I had available was 15 years old at that point, so the probes were worn out and visibility abysmal. I purposefully approached the adductor canal at a step angle to avoid the NVM and the redirected the needle laterally of the membrane and deposited local there. Seemed to work with no injury to NVM. Learning about NFCA forced me to revise my approach. 😊
Thank you I did it last month, it worked great, the patient only needed paracetamol and NSAIDs until he went home, it was ACL reconstruction, unfortanately we don't have nerve stimulator, but I do them under mild sedation
What’re your thoughts on the motor component of the NVM? Does it increase fall risk in your obese or elderly population? Do they need that Vastus Medialis for safe ambulation?
This is my question exactly…. Would love clarification on that. That nerve coverage has to increase the incidence of quad weakness for total knees in older petite females especially
I used to tell trainees that there are two approaches to adductor canal with regard to where you want your needle to be when injecting. (This is in a setting where we just want saphenous. We rarely do knees)
1) I usually place my needle just supra lateral to artery close to the s nerve.
2) Jeff Gadsen directs his needle through sartorious & places his needle just supramedial to the artery thus ensuring that he won’t hit the artery. and then when he sees the artery pushed down by the local he knows it’s in the right compartment and not intramuscular.
Apologies, if I have been misrepresenting your approach.
You make excellent videos and I am a huge fan of your content. I have been doing the total knee block for awhile now and am getting great results. During one of my long knee replacements, I had too much time on my hands and figured out a potentially great name for this 8 injection technique. As it is magic, it could be named the MAGiiC Block for: nerve to vastus Medials, Adductor canal, Geniculars, nerve to vastus Intermedius, iPACK, and Cuties(for AFCN).
Best video so far about Adductor canal block 👌🏻😉
Awesome video! My favorite channel for blocks!
Very nice and pragmatic. Very impressive video. Thank You.
You'r videos are always packed with both the fundamental knowledge, and the finer details! I'd like to ask about nerve blocks in the context of reduction of an ankle fracture, in the ED, which blocks would you go for? Many thanks in advance!
You’re such a blessing. Thank you 😊
Your video is always very informative.❤
Hi,Great video, can we ablate these nerves along with genicular nerves for pain relief in Knee OA patients? Will it provide better pain relief?
Typically we don't ablate these at the mid-thigh. The infra-patellar branch of the saphenous is often ablated (or treated with cryo-analgesia) on the medial side of the knee joint. I'd be concerned about ablating the nerve to vastus medialis...while it doesn't seem to contribute much to gross motor power in postop patients for a few days, I wouldn't want to knock it out for several months. Thanks for watching!
How to differentiate if muscle is getting directly stimulated or NVM is stimulated?
Any minimum current strength to differentiate?
Great content and images! Thanks for sharing! What ultrasound machine were you using if I may ask? Any one in particular you recommend?
Any chance you could make a how-to video on using peripheral nerve stimulator for blocks, for trainees/residents?
Your other videos on nerve stimulation don't really cover how to actually use the technique.
Great video as always!
What settings would you use for the nerve stimulator for the NVM part? Also when you get the NVM twitch are you then turning down the amplitude or withdrawing/redirecting the needle or any other changes to help ensure you're not intraneural?
Didn't learn nerve stim during training, but would like to add this NVM blockage to my adductor blocks and want to make sure I'm not missing anything. Thanks.
The well researched published articles on Dual Sub-sartorial Block [DSB] would give excellent clarity on the anatomical intricacies applicable here and exact differences btw a FT block & AC block
Jeff! Great video as always!
I grimaced as that horizontal needle went through the membrane towards saphenous nerve. Looked like it was going straight for the artery!
Check out "this video"... Which video?
Another great tutorial in an amazing series.
Keep up the great work!
Excellent video! Thank you!
Can you tell me some papers showing the technique
"take a shallow trajectory"
[Laughs in Texas 😂 land of whataburger thighs]
This has one of the best ultrasound/tissue diagram I've ever seen! I'm speaking on applied anatomy for vascular access. Do you mind if I use a section of it for a presentation?
Of course! Thanks for watching!
@@regionalanesthesiology 🙏🙏🙏
Jeff ! Do you use catether?! How many days?! Thanks
Also interested in this question. If yes, where would you leave the catheter?
Jeff pls read n reply comment
Great video. FYI your reference to last of the 3 videos/nerve block for superior postop pain for total knee arthroplasty doesn’t appear at end of the video? Are you referring to the AFCNs?
finally!!! some freaking sense about this stupid FT vs. AC debate!
Great video! Without the nerve stimulator (not every service has it), how can you do this? Try and error?
Amazing. Thanks for sharing 🎉
Hey Dude, from 3:51 min, the picture on US scan is marked wrongly: medial should be lateral and vice versa. Vastus Medialis is located on the medial side on the lower thigh but looking at your US picture it appears to be on the lateral side.
when you frog leg, the vastus medialis becomes "lateral" compared to adductor longus
How do you use the nerve stim for this? Are you going to 0.8 like in the video? Or adjusting to a lower Hz?
do u feel only adductor canal block is sufficient for TKR? along with block I ask my surgeon to infiltrate posteriorly capsule also
Great presentation...
omg the puns, i love this man so much
Are you blocking nerve to vastus medialis in post TKR
Can we have a workshop please❤
Thank you for another "AHA" moment
😮wow❤❤
the whale!!! ahhahah just amazing video!! thanks