Effect of iPACK and BiFeS Blocks on Quality of Recovery After Total Knee Arthroplasty

Sponsor
Ataturk University
Study ID
NCT07248072
Status
Recruiting
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Conditions

Eligibility Criteria

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

Interventions

  • Adductor Canal Block (ACB) Only — PROCEDURE
    An ultrasound-guided adductor canal block (ACB) will be performed using 15 mL of 0.25% bupivacaine. The probe will be placed on the proximal thigh to visualize the sartorius muscle and femoral artery. The needle will be advanced in-plane into the adductor canal, and correct placement will be confirmed with 2 mL saline before injection. This block aims to provide anterior knee analgesia while preserving quadriceps strength.
  • IPACK block — PROCEDURE
    The iPACK block will be performed by placing the ultrasound probe at the popliteal region to visualize the popliteal artery and posterior knee capsule. A needle will be advanced in-plane, and 25 mL of 0.25% bupivacaine will be injected between the artery and posterior capsule. This block targets posterior knee pain after total knee arthroplasty without causing motor block.
  • BiFeS Block — PROCEDURE
    The BiFeS block will be performed with the ultrasound probe placed laterally to visualize the femur cortex and the long and short heads of the biceps femoris muscle. The needle will be advanced in-plane into the potential space between the femur and the short head of the biceps femoris. After confirming position with 2 mL saline, 25 mL of 0.25% bupivacaine will be injected. This block provides posterolateral knee analgesia with limited motor involvement.

Study Details

This prospective, randomized, double-blind clinical trial aims to compare the effects of two different posterior knee analgesia techniques-iPACK block (Interspace Between the Popliteal Artery and the Capsule of the posterior Knee) and the Biceps Femoris Short Head (BiFeS) block-when combined with an adductor canal block (ACB) in patients undergoing elective unilateral total knee arthroplasty (TKA). Effective postoperative analgesia is essential for early mobilization, enhanced recovery, and patient satisfaction after TKA. Although ACB provides good anterior knee analgesia while preserving quadriceps strength, additional posterior knee analgesia is often required. The iPACK block is a commonly used technique that targets the posterior knee capsule, whereas the newer BiFeS block aims to provide more selective posterolateral sensory blockade with potentially reduced risk of motor involvement. However, comparative clinical data between these two techniques are limited. The primary objective of this study is to evaluate the difference between the iPACK and BiFeS blocks in terms of Quality of Recovery-15 (QoR-15) scores at 24 hours postoperatively. Secondary objectives include comparisons of postoperative pain scores, opioid consumption, time to first analgesic request, quadriceps and anterior tibialis muscle strength, functional test performance, time to mobilization, active range of motion, and the incidence of adverse events. A total of 74 adult patients scheduled for elective unilateral TKA under spinal anesthesia will be randomized in a 1:1 ratio into two groups: ACB + iPACK block or ACB + BiFeS block. All blocks will be performed under ultrasound guidance by an experienced anesthesiologist. Outcome assessments will be conducted by blinded investigators. The study aims to provide high-quality clinical evidence regarding the effectiveness of the BiFeS block compared to the widely used iPACK technique.

Key Dates

First listed
Nov 25, 2025
Start date
Dec 1, 2025
Status verified
May 2026
Primary completion
Jul 1, 2026
Completion
Jul 2, 2026

Study Design

Enrollment
74 participants (estimated)
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT

Arms

  • Active Comparator: Adductor Canal Block + iPACK Block
    Participants in this arm will receive an ultrasound-guided adductor canal block (ACB) using 15 mL of 0.25% bupivacaine, followed by an iPACK (Interspace Between the Popliteal Artery and the Capsule of the posterior Knee) block with 25 mL of 0.25% bupivacaine. Blocks will be performed under sterile ultrasound guidance by an experienced anesthesiologist who will not participate in postoperative assessments. All patients will receive standardized spinal anesthesia and perioperative analgesia.
  • Experimental: Adductor Canal Block + BiFeS Block
    Participants in this arm will receive an ultrasound-guided adductor canal block (ACB) using 15 mL of 0.25% bupivacaine, followed by a BiFeS (Biceps Femoris Short Head) block performed by injecting 25 mL of 0.25% bupivacaine into the potential space between the femur and the short head of the biceps femoris muscle. Procedures will be performed under sterile ultrasound guidance by an anesthesiologist not involved in postoperative assessments. All participants will receive standardized spinal anesthesia and perioperative analgesia.

Primary Outcome Measure

Quality of Recovery-15 (QoR-15) Score at 24 Hours [ Time Frame: 24 hours postoperatively ]

Central Contacts

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