Effect of Adding a Biceps Femoris Short Head Block to Adductor Canal Block for Analgesia After Total Knee Arthroplasty

NCT07803887 | Not Yet Recruiting DMC

• 1 other identifier: 10840098-202.3.02-446
• Study Type: interventional
• Target: 122
• Locations: 1 country
• Sites: 1

Brief Summary

Total knee arthroplasty (TKA) is frequently associated with moderate to severe postoperative pain, which may delay mobilization, increase opioid consumption, and impair functional recovery. Ultrasound-guided adductor canal block (ACB) is widely used as part of multimodal analgesia because it provides effective analgesia while preserving quadriceps muscle strength. However, ACB alone may provide insufficient analgesia for the posterior aspect of the knee. The biceps femoris short head (BiFeS) block is a novel ultrasound-guided regional anesthesia technique targeting the posterolateral sensory innervation of the knee and may enhance postoperative analgesia when combined with ACB. However, clinical evidence regarding its analgesic efficacy in patients undergoing total knee arthroplasty remains limited. This prospective, randomized, controlled trial aims to compare postoperative analgesia between ultrasound-guided adductor canal block alone and adductor canal block combined with a biceps femoris short head block in adult patients undergoing primary total knee arthroplasty under spinal anesthesia. Participants will be randomly assigned in a 1:1 ratio to receive either ACB alone or combined ACB plus BiFeS block. The primary outcome is cumulative opioid consumption during the first 48 postoperative hours. Secondary outcomes include postoperative pain intensity, time to first analgesic request, quadriceps muscle strength, functional recovery, postoperative recovery quality, postoperative nausea and vomiting, patient and surgeon satisfaction, length of hospital stay, and block-related complications.

Conditions

Knee Osteoarthritis (OA); Postoperative Pain

Keywords

Biceps Femoris Short Head Block; Adductor Canal Block; Total Knee Arthroplasty; Regional Anesthesia; Knee Osteoarthritis; Enhanced Recovery After Surgery (ERAS)

Outcome Measures

Primary Outcomes (1)

• Cumulative Opioid Consumption

  Cumulative opioid consumption during the first 48 postoperative hours, recorded as intravenous morphine equivalent dose (mg).

  From arrival in the post-anesthesia care unit until 48 hours after surgery

Secondary Outcomes (11)

• Postoperative Pain Intensity

  4, 8, 12, 24, and 48 hours after surgery

• Time to First Rescue Analgesic Administration

  During the first 48 postoperative hours

• Quadriceps Muscle Strength

  Preoperatively and at 8, 24, and 48 hours after surgery

• Functional Mobility

  24 and 48 hours after surgery

• Knee Range of Motion

  Preoperatively and at 12 and 24 hours after surgery

Study Arms (2)

Ultrasound-Guided Adductor Canal Block

ACTIVE COMPARATOR

Participants assigned to this arm will receive an ultrasound-guided adductor canal block before the induction of spinal anesthesia for primary unilateral total knee arthroplasty. All regional blocks will be performed according to a standardized study protocol. Perioperative anesthetic management, surgical procedures, and postoperative multimodal analgesia will be standardized for all participants.

Procedure: Ultrasound-Guided Adductor Canal Block

Ultrasound-Guided Adductor Canal Block Combined With Biceps Femoris Short Head Block

EXPERIMENTAL

Participants assigned to this arm will receive an ultrasound-guided adductor canal block combined with an ultrasound-guided biceps femoris short head block before spinal anesthesia for primary unilateral total knee arthroplasty. Both regional blocks will be performed according to a standardized study protocol. Perioperative anesthetic management, surgical procedures, and postoperative multimodal analgesic regimens will be standardized for all participants.

Procedure: Ultrasound-Guided Adductor Canal Block; Procedure: Ultrasound-Guided Biceps Femoris Short Head Block

Interventions

Ultrasound-Guided Adductor Canal Block PROCEDURE

An ultrasound-guided adductor canal block will be performed before the induction of spinal anesthesia using a standardized technique. Following ultrasound identification of the adductor canal, 30 mL of 0.25% bupivacaine will be injected into the adductor canal adjacent to the femoral artery to provide perioperative analgesia for primary unilateral total knee arthroplasty.

Ultrasound-Guided Adductor Canal Block; Ultrasound-Guided Adductor Canal Block Combined With Biceps Femoris Short Head Block

Ultrasound-Guided Biceps Femoris Short Head Block PROCEDURE

An ultrasound-guided biceps femoris short head block will be performed before the induction of spinal anesthesia using a standardized technique. Following ultrasound identification of the fascial plane adjacent to the short head of the biceps femoris muscle, 20 mL of 0.25% bupivacaine will be administered to provide additional posterolateral knee analgesia as an adjunct to the adductor canal block.

Ultrasound-Guided Adductor Canal Block Combined With Biceps Femoris Short Head Block

Eligibility Criteria

• Age: 18 Years - 80 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Scheduled for elective primary unilateral total knee arthroplasty under spinal -anesthesia.
• American Society of Anesthesiologists (ASA) physical status I-III.
• Body mass index (BMI) \<40 kg/m².
• Ability to understand the study procedures and provide written informed consent.

You may not qualify if:

• Refusal to participate or inability to provide informed consent.
• Body mass index 40 kg/m2 or higher.
• ASA physical status IV or V.
• Known allergy or hypersensitivity to local anesthetics, opioids, or other study -medications.
• Pregnancy or breastfeeding.
• Uncontrolled psychiatric disease or severe anxiety interfering with study participation.
• Pre-existing neuromuscular disease or peripheral neuropathy involving the operative limb.
• Chronic opioid use or opioid dependence.
• Chronic pain syndrome requiring regular analgesic therapy.
• Severe hepatic or renal insufficiency.
• Contraindications to spinal anesthesia or peripheral nerve block, including -coagulopathy, thrombocytopenia, local infection at the injection site, or patient refusal.
• Planned bilateral or revision total knee arthroplasty.

Sponsors & Collaborators

• Antalya Training and Research Hospital: lead

Study Sites (1)

Antalya Training and Research Hospital

Antalya, Antalya, 07100, Turkey (Türkiye)

Location

MeSH Terms

Conditions

Osteoarthritis, Knee; Pain, Postoperative

Condition Hierarchy (Ancestors)

Osteoarthritis; Arthritis; Joint Diseases; Musculoskeletal Diseases; Rheumatic Diseases; Postoperative Complications; Pathologic Processes; Pathological Conditions, Signs and Symptoms; Pain; Neurologic Manifestations; Signs and Symptoms

Study Officials

• Serhat Gulersen, MD,

  University of Health Sciences Türkiye, Antalya Training and Research Hospital

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Nilgun Kavrut Ozturk, MD,Professor

CONTACT

+905334196049; kavrut@yahoo.com

Serhat Gulersen, MD,

CONTACT

+905445336784; serhatgulersen@gmail.com

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: DOUBLE
• Who Masked: PARTICIPANT, OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER GOV
• Responsible Party: SPONSOR

Model Details: Eligible participants will be randomly allocated in a 1:1 ratio to receive either ultrasound-guided adductor canal block alone or ultrasound-guided adductor canal block combined with biceps femoris short head block. Postoperative outcomes will be assessed by an investigator blinded to group allocation.

Study Record Dates

• First Submitted: August 3, 2026
• First Posted: September 4, 2026
• Study Start: September 1, 2026
• Primary Completion (Estimated): February 20, 2027
• Study Completion (Estimated): March 20, 2027
• Last Updated: September 4, 2026

Record last verified: 2026-07

Data Sharing

• IPD Sharing: Will not share

Locations

TU (1)