Total knee arthroplasty is associated with moderate to severe postoperative pain, which may delay mobilization and recovery. Multimodal analgesia including regional anesthesia techniques is widely used to improve outcomes. The adductor canal block (ACB) provides anteromedial knee analgesia but may not adequately cover the posterolateral region. The biceps femoris short head (BiFeS) block is a novel motor-sparing regional anesthesia technique targeting the posterolateral capsule of the knee. This randomized controlled trial aims to compare the analgesic efficacy and functional outcomes of ACB combined with BiFeS block versus ACB alone in patients undergoing total knee arthroplasty. The primary outcome is posterior knee pain at postoperative 6 hours. Secondary outcomes include pain scores within 48 hours, opioid consumption, early and late functional recovery, and opioid-related adverse effects.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Enrollment
132
Ultrasound-guided adductor canal block performed with injection of local anesthetic into the adductor canal to block the saphenous nerve and provide postoperative analgesia following total knee arthroplasty.
Ultrasound-guided biceps femoris short head block performed with injection of local anesthetic between the biceps femoris short head and femur to target the posterolateral innervation of the knee for postoperative analgesia.
Sham ultrasound-guided biceps femoris short head block performed with injection of normal saline at the same anatomical location to maintain blinding without providing active analgesia.
Cukurova University
Adana, Saricam, Turkey (Türkiye)
Posterior Knee Pain Intensity
Posterior knee pain assessed using the Numeric Rating Scale (NRS, 0-10), where 0 indicates no pain and 10 indicates worst imaginable pain.
Time frame: 6 hours postoperatively
Postoperative Pain Intensity
Pain intensity at rest and during movement assessed using the Numeric Rating Scale (NRS, 0-10).
Time frame: 30 minutes, 1, 6, 12, 24, and 48 hours postoperatively
Total Opioid Consumption
Total opioid consumption measured from patient-controlled analgesia (PCA) device and additional opioid requirements, expressed in milligrams of morphine equivalent.
Time frame: 0-48 hours postoperatively
Rescue Analgesic Use
Requirement for additional analgesic medications (e.g., meperidine, paracetamol, ibuprofen) recorded as yes/no and total doses administered.
Time frame: 0-48 hours postoperatively
Functional Recovery
Functional recovery assessed by range of motion (ROM), quadriceps muscle strength, time to first ambulation, ability to walk 10 meters without assistance, and performance on the 5-times sit-to-stand test.
Time frame: 24 hours, 48 hours, and 6 weeks postoperatively
Quadriceps Muscle Strength
Quadriceps isometric muscle strength measured using a handheld dynamometer and expressed in Nm/kg.
Time frame: Preoperatively, 24 hours, 48 hours, and 6 weeks postoperatively
Time to First Ambulation
Time from the end of surgery to first successful ambulation, measured in hours.
Time frame: Within 48 hours postoperatively
Patient Satisfaction
Patient satisfaction with postoperative pain management assessed using a 4-point scale (excellent, good, moderate, poor).
Time frame: 48 hours postoperatively
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