Authors: Coral G et al.
A & A Practice, 20(3):e02143, March 2026
This case series evaluates the dual subsartorial block (DSB) as a regional anesthesia technique for anterior cruciate ligament (ACL) reconstruction, focusing on its ability to provide effective analgesia while preserving motor function.
ACL reconstruction is commonly associated with significant postoperative pain, and traditional regional techniques such as femoral nerve block or adductor canal block may either provide incomplete analgesia or cause undesirable motor weakness. The DSB is designed to address these limitations by targeting sensory innervation of the knee, particularly the popliteal plexus, while minimizing motor blockade.
In this series of eight patients undergoing ACL reconstruction under general anesthesia, the DSB was performed preoperatively using two ultrasound-guided injections beneath the sartorius muscle. The first injection targeted the distal femoral triangle, and the second targeted the distal adductor canal near the adductor hiatus. This dual approach is intended to provide broader sensory coverage, including anterior, medial, and potentially posterior knee structures through local anesthetic spread.
The results demonstrated consistently effective analgesia. Most patients reported pain scores below 4 at rest and with movement throughout the first 24 hours. Opioid requirements were minimal, with five of eight patients requiring no rescue opioids and the remaining three requiring only small doses.
Importantly, motor function was largely preserved. Six patients maintained full strength (5/5), while two had only mild weakness (4/5), suggesting that the DSB achieves a favorable balance between analgesia and motor preservation. This is particularly relevant for early mobilization and recovery protocols.
No block-related complications were reported, supporting the safety of the technique in this small cohort. The authors also highlight the potential for local anesthetic spread into the popliteal fossa, which may explain the improved coverage of posterior knee pain compared to more traditional blocks.
The findings align well with enhanced recovery after surgery (ERAS) principles, emphasizing opioid-sparing analgesia and early functional recovery. However, the study is limited by its small sample size, retrospective design, and lack of a comparison group, which restricts the ability to draw definitive conclusions about superiority over existing techniques.
Key Points
- Dual subsartorial block provides effective analgesia after ACL reconstruction
- Majority of patients had low pain scores and minimal opioid requirements
- Motor function is largely preserved, supporting early mobilization
- Technique may provide broader sensory coverage than traditional blocks
- No complications observed in this small case series
- Further randomized studies are needed to validate findings
What You Should Know
This is a promising regional technique that may offer the “sweet spot” we are always looking for—strong analgesia without sacrificing quadriceps function. If these results hold up in larger trials, the DSB could become a preferred approach for ACL surgery. For now, it is worth understanding the anatomy and technique, especially if you are aiming to improve pain control while maintaining early ambulation in your patients.
We want to thank A & A Practice for allowing us to summarize and share this important work with the anesthesia community.