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Thank you to the organizing committee for the fantastic opportunity to speak at the conference! 🙏 I truly enjoyed sharing insights and connecting with everyone. 💪 #IGCC2025 #Gastroenterology #HIPAC #PIPAC #Oncology #Innovation #MedicalConference #GICommunity
@ealjahdli

🎯 🚀 Forward Flow Forward: Mastering the Popliteal Pathway via Smart ACB Strategies 🛠
#RegionalAnesthesia #NerveBlocks #UltrasoundGuided #PeripheralNerveBlock #AnesthesiaEducation #AdductorCanalBlock #PoplitealPlexus #AnteriorApproach #DSB #HiPAC #4in1Block #KneeAnalgesia #MotorSparing #TipOfTheDay #MyRATips
Tip of the Day:
🧠The Adductor Canal: Nature’s Passageway to the Popliteal Fossa
👉The AC is a musculoaponeurotic tunnel, bounded by two muscles (VMM & ALM/AMM) and one aponeurosis (VAM).
👉It naturally connects the anterior thigh to the posterior thigh through the adductor hiatus.
👉 Using this anatomical passageway, local anesthetic can be directed from an anterior approach to reach posterior targets like the popliteal plexus and even sciatic nerve branches.
📢Volume Dynamics & Direction in ACB-Based Techniques
🔍 When performing ACBs for knee or below-knee surgeries, understanding how LA moves and how we can guide that movement is critical for:
🦵Targeting the popliteal plexus (for knee analgesia),
🦵Or reaching the sciatic nerve trunks (for foot/ankle surgery).
💡 Popliteal Plexus = Enough for Knee Surgery
✨LA spread to posterior capsule & intra-articular branches (tibial & obturator articular twigs) is usually sufficient for TKA and arthroscopy.
✨Achievable with 15–20 mL when injected in the PURPLE perivascular zone at the proximal AC (just distal to FT apex).
💡 Sciatic Trunk Coverage = Needed for Below-Knee Surgery
✨Full coverage of the TN & CPN requires: High-volume LA (30–40 mL) in the AC.
✨The drug follows the femoral artery through the adductor hiatus into the popliteal fossa and around the sciatic nerve.
📢📚 What Did Dye Studies Show?
📝Multiple dye and contrast studies have confirmed spread to the popliteal plexus when large volumes (20–30 mL) are injected perivascularly in the distal AC.
📝In the landmark Gautier et al. series, 20 mL of contrast injected into the AC showed dye around the sciatic nerve in all cases, with limited sensory or motor impact.
📝Similarly, Runge et al. and Goffin et al. (cadaveric work) demonstrated consistent spread into the popliteal fossa, especially when dye was injected 1–2 cm above the adductor hiatus.
📝Most importantly, Johnston et al. confirmed that dye injected into the distal AC could spread to the popliteal plexus, while distal FT injections did not.
📝Hi-PAC and 4-in-1 innovated further by extending the anterior spread to the sciatic trunk.
📝The only contradictory claim (RAPM, 2023) lacks dissection and underreports its own positive data.
💉 Where to Inject? The “Purple Zone”
🎯 Optimal target = deep to sartorius, lateral to femoral artery, and under the VAM.
🟣 This is the perivascular PURPLE zone, a conduit that sends LA through the adductor hiatus → popliteal fossa.
📏 How Much? Volume Matters
📍<10 mL: Often insufficient to reach the popliteal plexus or include major articular branches.
📍15-20 mL: Ideal for proximal AC – to achieve popliteal spread without sciatic involvement.
📍≥20 mL: Increases likelihood of sciatic spread, especially if injected distally in the AC.
⚙️ DSB Technique = Dual Injection for Strategic Spread
🔑Volume Efficiency + Direction Control
🔹 1st injection: 10-20 mL in distal FT pre-fills the proximal tract, restricting retrograde spread of the second injection.
🔹 2nd injection: 10–20 mL in AC moves distally, pushing the drug toward the popliteal plexus
✅ Key Advantage: DSB achieves popliteal plexus involvement with less total volume than needed in a single-shot ACB alone.
🧠 Concept: Blocking the Backdoor, Opening the Front - By “sealing off” the proximal path with the first bolus, DSB converts the second bolus into a distally driven column, minimizing leakage and maximizing effect.
🛑Why the RAPM (Smulders et al.) Study Missed the Mark?
🧟Cadaveric study, but no dissection❌.
🕓CT after 30 min - not real-time, no vascular flow, potential underestimation.
🧪Used 2 mL groups (!), only 30 mL showed popliteal spread in 3 cases - yet still concluded “no sciatic spread.”
❌ No comparison with prior positive studies
❌ Ignored key findings in 30 mL group
📛Titled with a strong claim despite contradictory findings: misleading, non-neutral, and goal-directed bias.
📉Contrast in CT can resemble soft tissue = interpretation bias.
🔄 Why Modify ACB Instead of Adding Blocks?
🚫 You don’t always need iPACK or posterior sciatic blocks.
✅ A single smart ACB (or DSB) can:
🔳Cover posterior capsule of the knee
🔳Reach articular sciatic branches
🔳Sometimes even spread to sciatic trunk (if needed, with higher volume)
🙌 Minimizes motor block, preserves function, reduces number of injections.
🟥Achieve foot analgesia from the front in below-knee surgeries when using Hi-PAC or 4-in-1.
🏠🔑 Final Take-Home Message
✅ Site trumps name: Where and how you inject matters more than the block label
✅ 15–20 mL in the purple zone = safe & effective posterior knee coverage
✅ DSB enhances forward flow, limiting volume while boosting effectiveness
✅ 30–40 mL directed distally (Hi-PAC/4-in-1) can reach sciatic trunk from anterior thigh
✅ One modified ACB can replace multiple blocks -if you respect anatomy and guide your volume!
✅Popliteal-plexus spread rarely weakens ankle; Hi-PAC/4-in-1 almost certainly will factor this into rehab plans. So, always use diluted LA for selective sensory blockade.
✅Document your plan - write “Popliteal-plexus target (20 mL)” or “Hi-PAC (35 mL) for below-knee surgery” so PACU and physio teams know what to expect.
🚀 One clever anterior injection can replace multiple blocks - if you know what you're doing.💡

Now this, 👇. This is how you get value from paying for a bluecheck.
Full exposé below 🔥 (h/t @LazarusLong13)
#HIPAC #CovidIsAirborne #StopHICPAC @OSHA_DOL @WorkSafeBC @OHCOWclinics @GovCanHealth
Curso gratuito "Herramientas interactivas de participación para el aprendizaje colaborativo #HIPAC" para PDI de @unicomplutense: aprender haciendo #learnignbydoing @wooclap @Mentimeter @MicrosoftES PPT @VevoxApp @padlet @GoogleForEdu #Forms y @Kahoot. Info
https://t.co/sDA6jqW3iU

🎉NUEVA EDICIÓN del curso #HIPAC
Hoy volvemos @inasiyu @dcaraban y @oriolTIC con otra edición del curso de formación del profesorado de la @unicomplutense “Herramientas interactivas para el aprendizaje colaborativo”
🛠️@Mentimeter @WooclapES @powerpoint @VevoxApp #GoogleForms

🏅Herramientas Interactivas de Participación para el Aprendizaje Colaborativo #HIPAC🏅
Comenzamos en 5 minutos con el curso para el #PDI @unicomplutense junto a @inasiyu @dcaraban y en el #HiperAula @hipac4u

🔥Comenzamos 🔥
Hoy a las 9:30 dará comienzo la primera edición del curso de la @unicomplutense “Herramientas interactivas para la participación y el aprendizaje colaborativo”, dentro del método #HIPAC
🎓@inasiyu @dcaraban y @oriolTIC
Current status and advances in total #paritonectomy and #HIPAC
Presenter Dr. Mainak
Moderator: Dr. Tarun
#SurgicalOncology,
Department of Surgical Oncology
IMS, BHU
For joining in, inbox your email address to receive link

A historic achievement for all Somalis. Thanks to Prez @M_Farmaajo and PM @HassanAKhaire to this critical milestone toward building a successful and prosperous Somalia. #DebtRelief #HIPAC #Somalia
IMF and World Bank consider #Somalia eligible for debt relief on initial assessment. This is an important milestone toward writing-off most of Somalia’s $5.3 billion debt. https://t.co/BU6M4zya0G

Awesome competition down at @LboroSport #Hipac , @Scott_Simpson_ & I on the decks and MCing the meet.
Man of the Match 3PBs for @ewalshpv great jumping dude! #polevault
RT @haydaycoffee Thanks for featuring #AtlanticCity, @AAAMidAtlantic! Come visit Hayday for coffee, along with the rest of #hipAC on @visitorangeloop. https://t.co/sb71GEw2vG #seemyHayday #landontheOL #thisisAC #doAC

Thanks for featuring #AtlanticCity, @AAAMidAtlantic! Come visit Hayday for coffee, along with the rest of #hipAC on @visitorangeloop. https://t.co/vsH3gvFCsS #seemyHayday #landontheOL #thisisAC #doAC

Hello... #Hipac #loughboroughuniversity #javelin #coaching #purple #track @thomasroehler #inthehouse #pilgrimage @ Loughborough University - Throws Training Camps https://t.co/nA96weaQlk

Great to bump into our friend @ParalympicsGB Star @RunJumpStefReid @LboroSport @lborouniversity #HiPAC when we were there for Rio’s very special #athletics #training session @BritAthletics #LoughboroughSport #StefReid #Paralympics #Legend #Inspirational #ThisGirlCan #ThisGirlDoes

BIG THX to the lovely staff @LboroSport @lborouniversity #HiPAC for the warm welcome back & for all their help in setting up a very special #athletics #training session for #BladeBoyRio! Watch out for the #BigReveal in 2 wks!🤐🤫😉 @BritAthletics @ParalympicsGB #LoughboroughSport

BIG THX to the lovely staff @LboroSport @lborouniversity #HiPAC for giving us such a warm welcome back and for all your help in making Rio’s visit so special! 🙌🏻 More pics/vids to follow 20/2/18!🤫😉🤐#LoughboroughUniversity @BritAthletics @ParalympicsGB #Athletics #Training

Rio was so excited for our #roadtrip to #HiPAC @LboroSport for a very special #athletics #training session - he couldn’t wait to run on his @ottobockuk 1E93 Runner Junior! @mat_dorsetortho @DorsetOrtho #DorsetOrthopaedic #Ottobock #Prosthetics #StriveForBetter #LoughboroughSport

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