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

Sponsor
Erzincan University
Study ID
NCT07242170
Status
Recruiting
Apply to this trial

Conditions

  • Post Operative Analgesia
  • Total Knee Arthroplasty

Eligibility Criteria

Sex
ALL
Age
18 Years - 75 Years
Healthy Volunteers
Not accepted

Interventions

  • 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.
  • 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.
  • 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.
  • 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.

Study Details

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.

Key Dates

First listed
Nov 21, 2025
Start date
Nov 1, 2025
Status verified
Jan 2026
Primary completion
Nov 1, 2026
Completion
Nov 1, 2026

Study Design

Enrollment
102 participants (estimated)
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE

Arms

  • Experimental: Adductor Canal Block + Sciatic Nerve Block
    Procedure: Mid-Adductor Canal Block Procedure: Sciatic Nerve Block
  • Experimental: Adductor Canal Block + BiFeS Block
    Procedure: Mid-Adductor Canal Block Procedure: BiFeS Block
  • Experimental: Adductor Canal Block + IPACK Block
    Procedure: Mid-Adductor Canal Block Procedure: IPACK Block

Primary Outcome Measure

Visual Analog Scale (VAS) Pain Score [ Time Frame: Postoperative 24 hours (measured at 1, 4, 8, 12, and 24 hours) ]

Central Contacts

Related Studies