RecruitingNot ApplicableNCT07561333

Comparing ACB+IPACK and ACB+BiFeS Block Combinations for Analgesia in Total Knee Arthroplasty

Comparison of Analgesic Efficacy of Infiltration Between the Popliteal Artery and Capsule of the Knee (IPACK) Versus Biceps Femoris Short Head Block Combined With Adductor Canal Block in Total Knee Arthroplasty

Sponsor

Hitit University

Enrollment

78 participants

Start Date

Oct 1, 2025

Study Type

INTERVENTIONAL

Conditions

Postoperative Pain Total Knee Arthroplasty

Summary

Total knee arthroplasty (TKA) is associated with severe postoperative pain that delays mobilization, prolongs hospital stay, and reduces patient satisfaction. Regional analgesia techniques have gained prominence due to their opioid-sparing effects and favorable complication profiles compared to general anesthesia. While adductor canal block (ACB) effectively manages anterior knee pain with preserved motor function, posterior knee pain remains a challenge. IPACK (Infiltration between the Popliteal Artery and Capsule of the Knee) and the Biceps Femoris Short Head (BiFeS) block are techniques targeting posterior capsule innervation without causing motor block.This prospective study aims to compare the postoperative analgesic efficacy of ultrasound-guided ACB+IPACK versus ACB+BiFeS block combinations in patients undergoing TKA under spinal anesthesia. Patients (ASA I-III, age 18-80, BMI ≤35) will be randomized into two groups (n=39 each). Primary outcomes include NRS pain scores at rest and on movement, and opioid consumption at 0, 1, 3, 6, 12, 18, and 24 hours postoperatively. Secondary outcomes include time to first mobilization, motor block incidence, quadriceps muscle strength assessment, PONV, and quality of recovery (QoR-15).

Eligibility

Min Age: 18 YearsMax Age: 80 Years

Inclusion Criteria6

Scheduled for primary total knee arthroplasty surgery
ASA physical status classification I-III
Hemodynamically stable
Age ≥ 18 years and ≤ 80 years
BMI ≤ 35 kg/m²
Signed written informed consent form

Exclusion Criteria19

Revision total knee arthroplasty surgery
Simultaneous bilateral total knee arthroplasty
BMI > 40 kg/m²
ASA physical status classification 4-5
Inability to perform NRS pain scoring
Known allergy to local anesthetics
Pregnancy or breastfeeding
Age < 18 or > 80 years
Uncontrolled anxiety disorder
Alcohol or drug dependency
Neuromuscular disease or peripheral nerve disease
High-dose opioid use within 3 days prior to surgery
Widespread chronic pain syndrome
Diabetes mellitus
Hepatic or renal insufficiency
Coagulation disorders
Current use of anticoagulant medications
Infection at the peripheral nerve block needle insertion site
Refusal to participate in the study

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Interventions

PROCEDUREACB+IPACK Group

Patients receiving ultrasound-guided adductor canal block (15 mL of 0.25% bupivacaine) combined with IPACK block (25 mL of 0.25% bupivacaine) for postoperative analgesia following total knee arthroplasty under spinal anesthesia.

PROCEDUREACB+BiFeS Group

Patients receiving ultrasound-guided adductor canal block (15 mL of 0.25% bupivacaine) combined with Biceps Femoris Short Head block (25 mL of 0.25% bupivacaine) for postoperative analgesia following total knee arthroplasty under spinal anesthesia.