Total Knee Arthroplasty
Conditions
Keywords
Total Knee Arthroplasty, Adductor Canal Block, Biceps Femoris Short Head Block, Postoperative Pain, Functional Recovery, Opioid Consumption, Knee Osteoarthritis
Brief summary
Total knee arthroplasty is associated with moderate to severe postoperative pain, which may delay mobilization and recovery. Multimodal analgesia including regional anesthesia techniques is widely used to improve outcomes. The adductor canal block (ACB) provides anteromedial knee analgesia but may not adequately cover the posterolateral region. The biceps femoris short head (BiFeS) block is a novel motor-sparing regional anesthesia technique targeting the posterolateral capsule of the knee. This randomized controlled trial aims to compare the analgesic efficacy and functional outcomes of ACB combined with BiFeS block versus ACB alone in patients undergoing total knee arthroplasty. The primary outcome is posterior knee pain at postoperative 6 hours. Secondary outcomes include pain scores within 48 hours, opioid consumption, early and late functional recovery, and opioid-related adverse effects.
Interventions
PROCEDUREAdductor Canal Block
Ultrasound-guided adductor canal block performed with injection of local anesthetic into the adductor canal to block the saphenous nerve and provide postoperative analgesia following total knee arthroplasty.
PROCEDUREBiceps Femoris Short Head Block
Ultrasound-guided biceps femoris short head block performed with injection of local anesthetic between the biceps femoris short head and femur to target the posterolateral innervation of the knee for postoperative analgesia.
PROCEDURESham Biceps Femoris Short Head Block
Sham ultrasound-guided biceps femoris short head block performed with injection of normal saline at the same anatomical location to maintain blinding without providing active analgesia.
Sponsors
Cukurova University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
* ASA I-III * Adult patients undergoing unilateral primary TKA * Planned spinal anesthesia * Written informed consent
Exclusion criteria
* Coagulopathy * Drug allergy * BMI \> 35 * Renal/hepatic failure * Chronic pain or opioid use * Depression or psychiatric disorder * Revision or bilateral TKA * Neurological deficits * Preoperative ROM \< 90°
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Posterior Knee Pain Intensity | 6 hours postoperatively | Posterior knee pain assessed using the Numeric Rating Scale (NRS, 0-10), where 0 indicates no pain and 10 indicates worst imaginable pain. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Postoperative Pain Intensity | 30 minutes, 1, 6, 12, 24, and 48 hours postoperatively | Pain intensity at rest and during movement assessed using the Numeric Rating Scale (NRS, 0-10). |
| Total Opioid Consumption | 0-48 hours postoperatively | Total opioid consumption measured from patient-controlled analgesia (PCA) device and additional opioid requirements, expressed in milligrams of morphine equivalent. |
| Rescue Analgesic Use | 0-48 hours postoperatively | Requirement for additional analgesic medications (e.g., meperidine, paracetamol, ibuprofen) recorded as yes/no and total doses administered. |
| Functional Recovery | 24 hours, 48 hours, and 6 weeks postoperatively | Functional recovery assessed by range of motion (ROM), quadriceps muscle strength, time to first ambulation, ability to walk 10 meters without assistance, and performance on the 5-times sit-to-stand test. |
| Quadriceps Muscle Strength | Preoperatively, 24 hours, 48 hours, and 6 weeks postoperatively | Quadriceps isometric muscle strength measured using a handheld dynamometer and expressed in Nm/kg. |
| Time to First Ambulation | Within 48 hours postoperatively | Time from the end of surgery to first successful ambulation, measured in hours. |
| Patient Satisfaction | 48 hours postoperatively | Patient satisfaction with postoperative pain management assessed using a 4-point scale (excellent, good, moderate, poor). |
Countries
Turkey (Türkiye)
Contacts
CONTACTDemet Lafli Tunay, M.D.
Outcome results
None listed