Postoperative Pain Management
Conditions
Keywords
regional anesthesia
Brief summary
This prospective, randomized, controlled, and multicenter clinical study aims to compare the postoperative analgesic efficacy of two regional anesthesia techniques commonly used in knee arthroscopy: adductor canal block (ACB) and combined adductor canal block plus biceps femoris short head (ACB+BiFeS) block. The study will evaluate postoperative pain control, opioid consumption, adverse effects, hospital stay, and patient satisfaction. Findings will help determine the most effective and safe method for postoperative analgesia in knee arthroscopy patients.
Detailed description
Knee arthroscopy is one of the most common orthopedic procedures and is frequently associated with significant postoperative pain. Effective multimodal analgesia is therefore essential to reduce opioid consumption, improve early mobilization, and enhance overall patient recovery. Among the regional anesthesia techniques, the adductor canal block (ACB) is well established as an effective motor-sparing block that provides analgesia to the medial and anterior aspects of the knee. However, patients often continue to experience posterolateral knee pain, which is not consistently relieved by ACB alone. Recent anatomical and cadaveric studies have described the biceps femoris short head (BiFeS) block as a promising technique for targeting the posterolateral knee compartment. The BiFeS block involves deposition of local anesthetic between the short head of the biceps femoris muscle and the lateral femoral cortex at the supracondylar level. Preliminary findings suggest that this block may provide effective analgesia for the posterolateral knee without causing significant motor impairment. This prospective, randomized, controlled, multicenter clinical trial is designed to evaluate whether the addition of the BiFeS block to standard ACB improves postoperative analgesia compared with ACB alone in patients undergoing knee arthroscopy under spinal anesthesia. The study will investigate pain scores at rest and during movement, total opioid consumption, side effects, rescue analgesic requirements, and quality of recovery. The dermatomal distribution of the blocks will be optionally assessed using cold testing. By directly comparing ACB and combined ACB+BiFeS block under standardized perioperative conditions, this study seeks to generate high-quality evidence on the clinical utility of BiFeS as an adjunct technique. The results are expected to guide anesthesiologists in selecting optimal regional analgesia strategies for knee arthroscopy, with the potential to improve patient satisfaction, reduce opioid-related complications, and shorten hospitalization.
Interventions
PROCEDUREAdductor Canal Block (ACB) Only
Ultrasound-guided injection of 10 mL 0.25% bupivacaine into the adductor canal targeting the femoral artery region, providing motor-sparing analgesia to the medial/anterior knee.
PROCEDUREbiceps femoris short head block + Adductor Canal Block (ACB)
Combination of adductor canal block (10 mL 0.25% bupivacaine) and biceps femoris short head block with 25 mL 0.25% bupivacaine, deposited at the interfascial plane between BiFeS muscle and lateral femoral cortex to extend analgesia to the posterolateral knee.
Sponsors
Kanuni Sultan Suleyman Training and Research Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
DOUBLE (Subject, Outcomes Assessor)
Masking description
Participants will be blinded to group allocation. Outcome assessors recording pain scores, opioid consumption, and side effects will be blinded to the intervention. The anesthesiologists performing the blocks cannot be blinded due to the nature of the procedures.
Intervention model description
Participants will be randomized in a 1:1 ratio to receive either an adductor canal block (ACB) or a combined adductor canal plus biceps femoris short head (ACB+BiFeS) block. Both interventions will be performed under ultrasound guidance at the end of surgery.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Age ≥ 18 years * ASA physical status I-III * Scheduled for elective knee arthroscopy under spinal anesthesia * Ability to provide written informed consent
Exclusion criteria
* Coagulopathy or bleeding diathesis * Current use of anticoagulant therapy * Known allergy or contraindication to local anesthetics used in the study * History of diabetes mellitus with neuropathy or other neuropathic disorders * Contraindications to regional anesthesia techniques * Refusal to participate
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Total Opioid Consumption (Tramadol, mg) | 24 hours | The total dose of tramadol administered via intravenous patient-controlled analgesia (PCA) device within the first 24 hours postoperatively will be recorded in milligrams. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Postoperative Pain with Movement and at rest (NRS) | At 0, 6, 12, and 24 hours after surgery | Pain intensity during knee movement will be assessed using the Numerical Rating Scale (0-10). |
| Incidence of Nausea and Vomiting | Within the first 24 hours postoperatively | Presence of nausea/vomiting and the requirement for antiemetic medications will be documented. |
| Quality of Recovery (QOR-15 score) | At 24 hours after surgery | Patient recovery quality will be assessed using the validated Quality of Recovery 15-item questionnaire (QOR-15). The scale includes 15 items, each scored from 0 to 10, producing a total score ranging from 0 to 150. Minimum score: 0 (poor recovery) Maximum score: 150 (excellent recovery) Interpretation: Higher scores indicate better postoperative recovery. |
| Dermatomal Spread of Block | 2nd hour postoperatively | Sensory block distribution will be assessed using a cold test to map dermatomal coverage. |
| Motor Blockade Incidence | Within the first 24 hours postoperatively | Patients will be evaluated for presence or absence of motor weakness attributable to the block. |
| Rescue Analgesia Requirement | Within the first 24 hours postoperatively | The number of patients requiring rescue analgesia (IV dexketoprofen 50 mg) will be recorded. |
Countries
Turkey (Türkiye)
Contacts
CONTACTEngin ihsan Turan, principal investigator
PRINCIPAL_INVESTIGATOREngin ihsan Turan, Specialist
Health Science University İstanbul Kanuni Sultan Süleyman Education and Training Hospital
Outcome results
None listed