Comparison of ACB With ACB and BiFeS Combination in Knee Arthroplasty Surgeries

Comparison of the Postoperative Analgesic Efficacy of the Combination of Adductor Canal Block and Biceps Femoris Short Head Block Versus Adductor Canal Block Alone in Patients Undergoing Total Knee Arthroplasty

The aim is to compare the postoperative analgesic effects of Adductor Canal and Biceps Femoris Short Head Blocks with Adductor Canal Block in patients undergoing Knee Arthroplasty surgery

Study Overview

• Status: Not yet recruiting
• Conditions: Knee Arthroplasty, Total; Knee Surgery; Postoperative Pain Management
• Intervention / Treatment: Procedure: Adductor Canal Block (ACB) Only; Procedure: Adductor Canal Block (ACB) + Biceps Femoris Short Head Block (BiFeS)

Detailed Description

Patients were divided into two randomized groups: Group 1 (ACB group, n=30) and Group 2 (ACB+BiFeS group, n=30). All patients will receive the same standard spinal anesthesia per hospital protocol. All blocks will be applied with the same ultrasonography and block equipment, and by the same physician. After the surgery, patients in Group 1 will receive Adductor Canal Block (ACB) with 20 mL of 0.25% bupivacaine. Patients in Group 2 will receive Adductor Canal Block with 20 mL of 0.25% bupivacaine and Biceps Femoris Short Head (BiFeS) with 20 mL of 0.25% bupivacaine. Routine analgesic procedure consisting of 3x400mg Ibuprofen will be followed postoperatively for 24 hours. Numeric Rating Scale (NRS) will be used to assess postoperative pain on 1st, 6th, 12th, 18th and 24th hours after the surgery. Tramadol 1mg/kg IV will be administered as a rescue analgesic for all patients if NRS score is higher than 4. Total Tramadol consumption will be calculated.

• Study Type: Interventional
• Enrollment (Estimated): 60
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: OĞUZ GÜNDOĞDU; Phone Number: +905545945469; Email: droguzgundogdu@gmail.com
• Study Contact Backup: Name: BUĞRA KARATAŞ; Phone Number: +905412453634; Email: bugrabgr60@hotmail.com

Study Locations

• Turkey (Türkiye)
  • Sivas
    • Sivas, Sivas, Turkey (Türkiye), 58140
      • Sivas Cumhuriyet University School of Medicine, Anesthesiology and Reanimation

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Adult patients over 18 years of age who underwent percutaneous nephrolithotomy under general anesthesia and were I-II-III according to the American Society of Anesthesiologists (ASA) risk classification were included in the study.

Exclusion Criteria:

• patients who did not give consent,
• patients with coagulopathy,
• patients with signs of infection at the block application site,
• patients using anticoagulants,
• patients with known allergies to any of the study drugs,
• patients with unstable hemodynamics,
• patients who could not cooperate during postoperative pain assessment
• patients who wanted to withdraw from the study,
• patients with alcohol and drug addiction,
• patients with musculoskeletal abnormalitie

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Quadruple

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Adductor Canal Block; For an adductor canal block, a high-frequency ultrasound probe will be placed on the anterior aspect of the patient's thigh, approximately at the midpoint between the inguinal crease and the medial condyle of the knee. (The depth is generally 3-5 cm). Using an in-plane technique, the needle will be advanced from lateral to medial, passing through the sartorius or vastus medialis muscle, and 20 mL of 0.25% bupivacaine will be injected around the femoral artery.	Procedure: Adductor Canal Block (ACB) Only; 20 mL of 0.25% bupivacaine
Active Comparator: Combination of Adductor Canal Block and Biceps Femoris Short Head Block; For adductor canal block, a high-frequency ultrasound probe will be placed on the anterior aspect of the patient's thigh, approximately at the midpoint between the inguinal crease and the medial condyle of the knee. (The depth is generally 3-5 cm). Using in-plane technique, the needle passing through the sartorius or vastus medialis muscle, and 20 mL of 0.25% bupivacaine will be injected around the femoral artery. For BiFeS block, a high-frequency ultrasound probe will be placed on the distal posterior aspect of the thigh. The Biceps Femoris Short Head (BiFeS) muscle will be visualized at the distal lateral part of the femur, near the lateral supracondylar line, and the needle tip will be placed at the interface between the BiFeS and the lateral supracondylar line of the femur. 20 mL of 0.25% bupivacaine will be injected, and during the injection, it will be confirmed by ultrasound that the solution lifts the muscle and spreads along the bone surface.	Procedure: Adductor Canal Block (ACB) + Biceps Femoris Short Head Block (BiFeS); 20 mL of 0.25% bupivacaine

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
1. Numeric Rating Scale (NRS) Scores	Numerical rating scale is used for pain assessment. The scores of the numerical rating scale changes between 0 to 10 points. 10 points mean "the most severe pain that the patient ever had". 0 point means "there is no pain." Higher scores mean worse outcome.	Postoperative 24 hours

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Total tramadol consumption	Postoperative total analgesic need was recorded as "milligram" in unit.	Postoperative 24 hours

Collaborators and Investigators

• Sponsor: Cumhuriyet University
• Investigators: Principal Investigator: OĞUZ GÜNDOĞDU, Sivas Cumhuriyet University School of Medicine, Anesthesiology and Reanimation; Study Chair: BUĞRA KARATAŞ, Sivas Cumhuriyet University School of Medicine, Anesthesiology and Reanimation

Study record dates

Study Major Dates

• Study Start (Estimated): November 20, 2025
• Primary Completion (Estimated): October 25, 2026
• Study Completion (Estimated): November 25, 2026

Study Registration Dates

• First Submitted: November 14, 2025
• First Submitted That Met QC Criteria: November 14, 2025
• First Posted (Estimated): November 18, 2025

Study Record Updates

• Last Update Posted (Actual): November 25, 2025
• Last Update Submitted That Met QC Criteria: November 20, 2025
• Last Verified: November 1, 2025

More Information

Terms related to this study

• Keywords: postoperative pain; knee arthroplasty; regional anesthesia; biceps femoris short head; bifes; adductor canal blok
• Additional Relevant MeSH Terms: Pain; Neurologic Manifestations; Postoperative Complications; Pathologic Processes; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Pain, Postoperative; Socioeconomic Factors; Population Characteristics; Demography; Family Characteristics; Marital Status; Single Person
• Other Study ID Numbers: 2025-09/52

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No