Supplementary Nerve Blocks Added to the Adductor Canal Block for Postoperative Pain Management in Primary Total Knee Arthroplasty: A Randomized Controlled Comparison of Sciatic, BiFeS, and IPACK Techniques

NCT07242170 | Recruiting

• 1 other identifier: ErzincanU-ANESTEZİYOLOJİ-MS-01
• Study Type: interventional
• Target: 102
• Locations: 1 country
• Sites: 1

Brief Summary

Postoperative pain following total knee arthroplasty (TKA) is a significant clinical problem that delays early mobilization, reduces patient satisfaction, and increases analgesic requirements. The adductor canal block (ACB), which aims to provide analgesia while preserving motor function, is widely used in postoperative pain management after TKA. However, clinical and anatomical studies have demonstrated that ACB is effective only in the anteromedial sensory innervation of the knee and does not adequately block pain originating from the posterior knee capsule. This limitation reduces analgesic effectiveness, particularly in patients with a prominent posterior pain component. The sciatic nerve block has long been considered the gold standard for managing posterior knee pain. However, due to disadvantages such as motor weakness and delayed rehabilitation, current pain management protocols increasingly favor motor-sparing and complementary approaches such as the Biceps Femoris Short Head (BiFeS) block and the Interspace Between the Popliteal Artery and the Capsule of the posterior Knee (IPACK) block for posterior knee analgesia. In light of this information, the aim of our study is to guide clinical practice by comparing the postoperative analgesic efficacy, motor function outcomes, and patient satisfaction associated with sciatic nerve, BiFeS, and IPACK block techniques-each administered as a supplement to the adductor canal block-in patients undergoing total knee arthroplasty, with the ultimate goal of determining the optimal block combination for postoperative pain control.

Conditions

Post Operative Analgesia; Total Knee Arthroplasty

Keywords

Adductor Canal Block; Sciatic Nerve Block; Biceps Femoris Short Head Block; Interspace Between the Popliteal Artery and the Capsule of the posterior Knee block; post operative pain

Outcome Measures

Primary Outcomes (1)

• Visual Analog Scale (VAS) Pain Score

  Pain intensity will be assessed using the Visual Analog Scale (VAS), a 10-cm horizontal line with endpoints representing the extremes of pain (0 = "no pain," 10 = "worst imaginable pain"). Patients will mark their perceived pain level, and the distance (in cm or mm) from the "no pain" anchor will be recorded as the VAS score. Measurements will be performed at rest. A VAS score below 3 indicates mild pain and adequate analgesia.

  Postoperative 24 hours (measured at 1, 4, 8, 12, and 24 hours)

Secondary Outcomes (5)

• Modified Bromage Scale

  24 hours

• QoR-40 (Quality of Recovery-40) Questionnaire

  24 hours

• Postoperative Opioid Requirement

  24 hours

• Time to First Opioid Requirement

  24 hours

• Peroneal nerve motor function

  24 hours

Study Arms (3)

Adductor Canal Block + Sciatic Nerve Block

EXPERIMENTAL

Procedure: Mid-Adductor Canal Block Procedure: Sciatic Nerve Block

Procedure: Adductor canal block; Procedure: Sciatic Nerve Block

Adductor Canal Block + BiFeS Block

EXPERIMENTAL

Procedure: Mid-Adductor Canal Block Procedure: BiFeS Block

Procedure: Adductor canal block; Procedure: BiFeS Block (Biceps Femoris Short Head Block)

Adductor Canal Block + IPACK Block

EXPERIMENTAL

Procedure: Mid-Adductor Canal Block Procedure: IPACK Block

Procedure: Adductor canal block; Procedure: IPACK block

Interventions

IPACK block PROCEDURE

IPACK Block An ultrasound-guided IPACK (Interspace Between the Popliteal Artery and the Capsule of the Posterior Knee) block using 20 mL of local anesthetic solution (10 mL 0.25% bupivacaine + 10 mL 0.9% saline) to provide posterior knee capsular analgesia while sparing motor function.

Adductor Canal Block + IPACK Block

Sciatic Nerve Block PROCEDURE

Sciatic Nerve Block An ultrasound-guided sciatic nerve block performed at the proximal thigh level using 20 mL of local anesthetic solution (10 mL 0.25% bupivacaine + 10 mL 0.9% saline) to provide posterior knee analgesia.

Adductor Canal Block + Sciatic Nerve Block

Adductor canal block PROCEDURE

Adductor Canal Block An ultrasound-guided injection of 20 mL local anesthetic solution (10 mL 0.25% bupivacaine + 10 mL 0.9% saline) administered in the mid-portion of the adductor canal to provide motor-sparing analgesia to the anteromedial knee.

Adductor Canal Block + BiFeS Block; Adductor Canal Block + IPACK Block; Adductor Canal Block + Sciatic Nerve Block

BiFeS Block (Biceps Femoris Short Head Block) PROCEDURE

BiFeS Block (Biceps Femoris Short Head Block) An ultrasound-guided injection targeting the short head of the biceps femoris muscle to selectively block sensory branches contributing to posterior knee pain. A total of 20 mL of local anesthetic (10 mL 0.25% bupivacaine + 10 mL 0.9% saline) is administered.

Adductor Canal Block + BiFeS Block

Eligibility Criteria

• Age: 18 Years - 75 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Patients classified as American Society of Anesthesiologists (ASA) physical status I-III
• Patients undergoing primary total knee arthroplasty
• Patients undergoing unilateral total knee arthroplasty
• Patients between 18 and 75 years of age

You may not qualify if:

• Patients classified as American Society of Anesthesiologists (ASA) physical status IV or higher
• Patients undergoing revision total knee arthroplasty
• Patients undergoing bilateral total knee arthroplasty
• Patients with neuromuscular disease
• Patients who decline to participate in the study
• Patients with cognitive dysfunction
• Patients with known drug allergies
• Patients with a history of local anesthetic systemic toxicity
• Patients with neurological dysfunction
• Patients with bleeding diathesis
• Pregnant patients

Sponsors & Collaborators

• Erzincan University: lead

Study Sites (1)

Erzincan Binali Yıldırım Üniversitesi

Erzincan, Merkez, 24000, Turkey (Türkiye)

RECRUITING

MeSH Terms

Conditions

Pain, Postoperative

Condition Hierarchy (Ancestors)

Postoperative Complications; Pathologic Processes; Pathological Conditions, Signs and Symptoms; Pain; Neurologic Manifestations; Signs and Symptoms

Central Study Contacts

mustafa somunkıran, anesthesiology resident

CONTACT

+905536327870; msomunkran@gmail.com

fethi akyol, Assistant Professor

CONTACT

+905055422992; fethi24@windowslive.com

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: TRIPLE
• Who Masked: PARTICIPANT, INVESTIGATOR, OUTCOMES ASSESSOR
• Purpose: SUPPORTIVE CARE
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Anesthesiology resident

Model Details: prospective, single-center, double-blind, randomized controlled trial

Study Record Dates

• First Submitted: November 17, 2025
• First Posted: November 21, 2025
• Study Start: November 1, 2025
• Primary Completion (Estimated): November 1, 2026
• Study Completion (Estimated): November 1, 2026
• Last Updated: January 13, 2026

Record last verified: 2026-01

Data Sharing

• IPD Sharing: Will not share

Locations

TU (1)