so i used to do about mid thigh now i've come a little bit higher getting a little more proximal so you can see the sartorius muscle he's got a nice size sartorius muscle the femoral artery here on the left the vein is just deep to the artery and we just want to pop through the uh adductor canal fascia there put our catheter down the leg okay rock you gotta mark let's mark that see where we're going i got rocky the multi-purpose man we're going to flush through this we're going to flush through this really well make sure there's no air in in that line because they'll really mess up our ultrasound image nice image here of the sartorius we'll put a little number shot in here okay so big sting on three don't jump on me now one two three stay here that boy that a boy a little burn right here now okay boom good job you're doing great so this is part three of our acl blocks we've done the genicular and the and the eye pack now we're going to put in our adductor canal catheter i'll come a little more proximal than most people i think it gets the both nerves really well the saviness and the nerve to the vastus because they're pretty close together up here a lot of pressure boss okay you're doing good you're doing great here comes our needle as you can see with this clarius machine very small easy to use and you can have great visualization of the needle and the muscles that you need to see we're coming through we've got a nerve stimulant later on so we've we get near the nerve to the vastus it'll should twitch we're not getting any twitch so we'll go right on through the fascia of the sartorius boom okay rocky give us five right there okay five more two three five okay i'm gonna scan down the leg just a little bit so you can see the spread down the leg okay five more here got our image we should see the local coming down a little more distal to the needle and i'll come back here to the needle and we'll put our catheter in right there there you go perfect so we can see our needle real well to slide in our catheter and i've got the bevel turned down the leg towards the knee so we want the catheter to come in and then slide along parallel to the artery and the nerve and go down three or four centimeters okay i want it about right there and see our catheter coming out right there going down the leg boom let's put our alligator clip on here all right you see the catheter right there on the ultrasound image okay you down a little bit okay rocky's gone down the leg with the probe since we put the catheter in here but we threaded it down so we're gonna see the spread down here let's take a look one two three you can see it over there under the artery little air let's put just another touch of air in there one two three boom go down just a little bit more come back right there okay one two three you can see the spread of the local where that air was right in there under the artery so it's going to open up the space where the uh saphenous nerve and the nerve to the vastus run should have a good block out of this so we'll wrap this up this is the three blocks for an acl a dutch canal catheter along with an ipac and a superior genicular nerve block you
