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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.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| ACB + BiFeS | Experimental | Participants receive spinal anesthesia followed by an ultrasound-guided adductor canal block and a biceps femoris short head block using local anesthetic for postoperative analgesia. |
|
| ACB + sham BiFeS | Active Comparator | Participants receive spinal anesthesia followed by an ultrasound-guided adductor canal block and a sham biceps femoris short head block using normal saline. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Adductor Canal Block | Procedure | 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. |
| Measure | Description | Time Frame |
|---|---|---|
| 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. | 6 hours postoperatively |
| Measure | Description | Time Frame |
|---|---|---|
| Postoperative Pain Intensity | Pain intensity at rest and during movement assessed using the Numeric Rating Scale (NRS, 0-10). | 30 minutes, 1, 6, 12, 24, and 48 hours postoperatively |
| Total Opioid Consumption |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Demet Lafli Tunay, M.D. | Contact | +905358685831 | dlafli@yahoo.com |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Cukurova University | Adana | Saricam | 01330 | Turkey (Türkiye) |
Individual participant data will not be shared.
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| ID | Term |
|---|---|
| D010149 | Pain, Postoperative |
| D020370 | Osteoarthritis, Knee |
| ID | Term |
|---|---|
| D011183 | Postoperative Complications |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D010146 | Pain |
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| Biceps Femoris Short Head Block | Procedure | 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 Biceps Femoris Short Head Block | Procedure | 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. |
|
Total opioid consumption measured from patient-controlled analgesia (PCA) device and additional opioid requirements, expressed in milligrams of morphine equivalent.
| 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. | 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. | 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. | 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. | Within 48 hours postoperatively |
| Patient Satisfaction | Patient satisfaction with postoperative pain management assessed using a 4-point scale (excellent, good, moderate, poor). | 48 hours postoperatively |
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |
| D010003 | Osteoarthritis |
| D001168 | Arthritis |
| D007592 | Joint Diseases |
| D009140 | Musculoskeletal Diseases |
| D012216 | Rheumatic Diseases |