Comparison Between Combined Biceps Femoris Short Head Block and Adductor Canal Block Versus Genicular Nerve Block

Enhanced Analgesia in Elderly After Total Knee Arthroplasty Using Combined Biceps Femoris Short Head Block and Adductor Canal Block Versus Genicular Nerve Block

The purpose of this study is to compare the analgesic outcomes (time to first analgesic request, total amount of analgesic consumption, and pain scores) following total knee arthroplasty by either combined biceps femoris short head block and adductor canal block or genicular nerve block in elderly patients.

Study Overview

• Status: Not yet recruiting
• Conditions: Knee Arthroplasty, Total
• Intervention / Treatment: Other: Combined biceps femoris short head block and adductor canal block; Other: Genicular nerve block

• Study Type: Interventional
• Enrollment (Estimated): 50
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Marwa M Medhat, M.D; Phone Number: 01002828937; Email: medhatmarwa9@gmail.com
• Study Contact Backup: Name: Howida A Kamal, M.D; Phone Number: 01225096755; Email: K.Howida@yahoo.com

Study Locations

• Egypt
  • Zagazig, Egypt
    • Faculty of Medicine,Zagazig University
    • Contact: Marwa M Medhat, M.D; Phone Number: 01002828937; Email: medhatmarwa9@gmail.com

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

• patient acceptance
• Physical status: ASA I, II and Ⅲ.
• Body mass index (BMI): 18.5 - 35 kg/m2.
• Type of operations: total knee arthroplasty.

Exclusion Criteria:

• Known hypersensitivity to dexamethasone or bupivacaine.
• Coagulation disorders or taking drugs affect surgical hemostasis.
• Patients with pre-existing neurological deficits.
• Uncooperative patient or with altered mental status.
• Patient with advanced cardiovascular or respiratory diseases or uncontrolled diabetes

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Group (C); The patient will receive combined biceps femoris short head block and adductor canal block	Other: Combined biceps femoris short head block and adductor canal block; Adductor Canal Block high-frequency probe will be placed transversely on the anterior thigh midpoint between inguinal crease and medial condyle (depth 3-5 cm). The needle will be advanced in-plane from lateral to medial through sartorius or vastus medialis muscle toward the femoral artery. Then (10 ml of 0.25% bupivacaine and 2 mg dexamethasone) will be injected after negative aspiration, with confirming spread around the artery without vascular puncture. Biceps femoris short head block The probe will be placed on the distal posterior thigh to visualize biceps femoris muscle near the lateral supracondylar line of the femur. The needle will be inserted to the interface between biceps femoris and femur cortex. Then (25 ml of 0.25% bupivacaine and 2 mg dexamethasone), with observing muscle lift and circumferential spread along the bone surface .
Active Comparator: Group(G); The patient will receive genicular nerve block	Other: Genicular nerve block; Position the patient will be placed in supine position with the knee slightly flexed via a pillow in the popliteal fossa. Use a high-frequency linear ultrasound transducer. Superolateral genicular nerve (SLGN): the transducer will be placed coronally over lateral femoral epicondyle, with sliding proximally to femur metaphysis; identifying artery between vastus lateralis fascia and bone. Superomedial genicular nerve (SMGN): the transducer will be placed coronally over medial femoral epicondyle, proximal to adductor tubercle at femur metaphysis; artery between vastus medialis fascia and bone. Inferomedial genicular nerve (IMGN): the transducer will be placed coronally over medial tibial condyle, distal to metaphysis; artery beneath medial collateral ligament. • Inferolateral genicular nerve (ILGN, optional): the transducer will be placed coronally over lateral tibial epicondyle to fibula head; artery between collateral ligament and tibia

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Time of first rescue analgesia (naluphine)	to the duration from the block to the moment when the patient first requires or requests supplemental nalbuphine due to breakthrough pain	24 hours postoperative

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
patient's satisfaction	The patients will be asked to rate the overall degree of satisfaction of the analgesia by using a 5-points likert-like verbal scale (1 = very dissatisfied analgesia, 2 = dissatisfied analgesia, and 3 = neutral, 4=satisfied analgesia, and 5=very satisfied analgesia)	24 hours postoperative
block performance time	time refers to the duration required to prepare, image (e.g., via ultrasound), insert the needle, and inject local anesthetic to complete a regional nerve block procedure.	time of performance of the block
Pain intensity	10-point NRS [(0 = no pain, 10 = worst imaginable pain), 1-3: Mild pain (nagging, annoying, slightly interfering with activities of daily living (ADLs), 4 - 6: Moderate pain (significantly interfering with ADLs, 7 - 10: Severe pain (disabling, unable to perform ADLs)	30 minutesn2, 4, 8, 12, 18 , and 24 hours postoperative
Total amount of rescue analgesia (nalbuphine)	the cumulative dose of nalbuphine administered as supplemental pain relief during a defined postoperative observation period, typically when pain scores exceed a predefined threshold like NRS ≥4	first 24 hours postoperative
assess functional recovery	(knee range of motion active flexion /extension,	at 12 hours and 24 hours postoperative
Block related complications	(motor weakness, hematoma, local anesthetic toxicity,..)	24 hours postoperative

Collaborators and Investigators

• Sponsor: Zagazig University
• Investigators: Study Director: Howida A Kamal, M.D, faculty of medicine,zagazig university Egypt

Publications and helpful links

General Publications

• You D, Qin L, Li K, Li D, Zhao G, Li L.,et al. A meta-analysis on advantages of peripheral nerve block post-total knee arthroplasty. Korean J Pain 2021; 34:271-287.

Study record dates

Study Major Dates

• Study Start (Estimated): February 15, 2026
• Primary Completion (Estimated): August 15, 2026
• Study Completion (Estimated): November 15, 2026

Study Registration Dates

• First Submitted: February 4, 2026
• First Submitted That Met QC Criteria: February 11, 2026
• First Posted (Actual): February 18, 2026

Study Record Updates

• Last Update Posted (Actual): February 18, 2026
• Last Update Submitted That Met QC Criteria: February 11, 2026
• Last Verified: February 1, 2026

More Information

Terms related to this study

• Other Study ID Numbers: ZU-IRB#2002/28-Jan-2026

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

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