Biceps Femoris Short Head (BiFeS) Block and Adductor Canal Block for Postoperative Analgesia Following Total Knee Arthroplasty (BiFeS Adductor)

A Comparison of the Effects of Biceps Femoris Short Head Block and Adductor Canal Block in Total Knee Arthroplasty on Postoperative Analgesia Using Multimodal Analgesia Methods

This prospective randomized controlled study aims to evaluate the effect of ultrasound-guided Biceps Femoris Short Head (BiFeS) block combined with adductor canal block on postoperative opioid consumption and pain control in patients undergoing elective total knee arthroplasty under spinal anesthesia.

A total of 60 patients aged 18-80 years with ASA physical status I-III scheduled for unilateral elective total knee arthroplasty will be randomized into two groups. The intervention group will receive spinal anesthesia followed by BiFeS block and adductor canal block before surgery, in addition to standard multimodal analgesia and postoperative morphine patient-controlled analgesia (PCA). The control group will receive spinal anesthesia and standard multimodal analgesia with postoperative morphine PCA without peripheral nerve block.

The primary outcome is total morphine consumption during the first 24 postoperative hours. Secondary outcomes include postoperative pain scores assessed by Numeric Rating Scale (NRS), time to first analgesic requirement, time to first foot movement, and Quality of Recovery-15 (QoR-15) scores.

Study Overview

• Status: Not yet recruiting
• Conditions: Total Knee Arthroplasty; Postoperative Pain Following Knee Arthroplasty
• Intervention / Treatment: Procedure: Procedure: Biceps Femoris Short Head Block; Procedure: Procedure: Spinal Anesthesia

Detailed Description

Total knee arthroplasty is associated with significant postoperative pain and high opioid consumption. Peripheral nerve blocks are increasingly used as part of multimodal analgesia strategies to reduce opioid requirements and improve postoperative recovery.

This prospective, randomized, single-center clinical study will be conducted at Kayseri City Hospital Department of Anesthesiology and Reanimation. Sixty adult patients undergoing elective unilateral total knee arthroplasty under spinal anesthesia will be enrolled after written informed consent.

Participants will be randomized into two groups using the closed envelope method.

Intervention Group (n=30):

Patients will receive spinal anesthesia with 3.5-4 mL 0.5% hyperbaric bupivacaine. Before surgical incision, ultrasound-guided BiFeS block will be performed using 25 mL of 0.25% bupivacaine, followed by ultrasound-guided adductor canal block using 15 mL of 0.25% bupivacaine.

Control Group (n=30):

Patients will receive spinal anesthesia only without peripheral nerve block.

All patients will receive standard multimodal analgesia including intravenous paracetamol 1 g every 8 hours and intravenous dexketoprofen 50 mg every 12 hours. Postoperative analgesia will be provided using morphine PCA prepared as 1 mg/mL concentration with 15-minute lockout interval and maximum 4 boluses per hour.

Rescue analgesia will be administered as intravenous fentanyl 25 mcg in patients with NRS score ≥4 despite PCA use.

Primary outcome measure is total morphine consumption during the first 24 postoperative hours.

Secondary outcome measures include Numeric Rating Scale pain scores at postoperative 1, 6, 12, and 24 hours, time to first analgesic requirement, time to first active foot movement, rescue analgesic requirement, and postoperative Quality of Recovery-15 scores.

The study hypothesis is that combined BiFeS and adductor canal block will reduce postoperative opioid consumption and improve recovery quality compared with standard multimodal analgesia alone.

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

Contacts and Locations

• Study Contact: Name: Omer Kayar, Medicinae Doctor; Phone Number: +90 531 578 90 37; Email: dr.omer.kayar@hotmail.com

Study Locations

• Turkey (Türkiye)
  • Kocasinan
    • Kayseri, Kocasinan, Turkey (Türkiye), 38080
      • Kayseri City Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Patients aged 18 and older
• ASA I-III
• Patients scheduled for elective unilateral knee replacement
• Eligibility for and consent to spinal anesthesia

Exclusion Criteria:

• History of allergy or anaphylaxis to local anesthetics, animal gelatin, or chlorhexidine
• Bleeding diathesis/inability to discontinue anticoagulants
• Infection (at the injection site/sepsis)
• Neurological disorders or cognitive impairment affecting pain perception
• Pregnancy, breastfeeding
• Patients under 18 years of age

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Supportive Care
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Triple

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Block Group; Patients receive spinal anesthesia followed by ultrasound-guided BiFeS block and adductor canal block before surgery, plus standard multimodal analgesia and morphine PCA.	Procedure: Procedure: Biceps Femoris Short Head Block; Patients will receive spinal anesthesia followed by ultrasound-guided Biceps Femoris Short Head (BiFeS) block using 25 mL of 0.25% bupivacaine and adductor canal block using 15 mL of 0.25% bupivacaine before surgery. Standard multimodal analgesia will be provided using intravenous paracetamol and dexketoprofen, along with postoperative patient-controlled analgesia with morphine for 24 hours.; Other Names: Procedure: Adductor Canal Block; Drug: Morphine PCA; Drug: Paracetamol; Drug: Dexketoprofen; Drug: Fentanyl
Active Comparator: Multimodal Analgesia Group; Patients receive spinal anesthesia only, followed by standard multimodal analgesia and morphine PCA.	Procedure: Procedure: Spinal Anesthesia; Patients will receive spinal anesthesia without peripheral nerve block. Standard multimodal analgesia will be provided using intravenous paracetamol and dexketoprofen, along with postoperative patient-controlled analgesia with morphine for 24 hours.; Other Names: Drug: Morphine PCA; Drug: Paracetamol; Drug: Dexketoprofen; Drug:Fentanyl

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Total Morphine Consumption in 24 Hours	Total cumulative morphine consumption measured from patient-controlled analgesia device during the first 24 postoperative hours.	Within the first 24 hours after surgery

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Numeric Rating Scale (NRS) Pain Scores	Pain intensity measured using NRS at rest (0-10 scale).	Postoperative 1, 6, 12, and 24 hours
Time to First Analgesic Requirement	Time from end of surgery to first patient-reported pain requiring analgesic medication.	24 hours
Time to First Foot Movement	Time from completion of surgery to first active foot movement.	24 hours
QoR-15 Score	Postoperative quality of recovery will be assessed using the validated 15-item Quality of Recovery questionnaire (QoR-15), which evaluates patient well-being, physical comfort, emotional state, psychological support, and pain. Total scores range from 0 to 150, with higher scores indicating better postoperative recovery.	24 hours postoperatively

Collaborators and Investigators

• Sponsor: Ömer Kayar

Study record dates

Study Major Dates

• Study Start (Estimated): June 2, 2026
• Primary Completion (Estimated): June 2, 2027
• Study Completion (Estimated): July 2, 2027

Study Registration Dates

• First Submitted: May 5, 2026
• First Submitted That Met QC Criteria: May 5, 2026
• First Posted (Actual): May 11, 2026

Study Record Updates

• Last Update Posted (Actual): May 13, 2026
• Last Update Submitted That Met QC Criteria: May 9, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Keywords: Postoperative Pain; BiFeS; BiFeS and Adductor Canal Block
• Additional Relevant MeSH Terms: Pain; Neurologic Manifestations; Postoperative Complications; Pathologic Processes; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Pain, Postoperative; Organic Chemicals; Heterocyclic Compounds, 1-Ring; Heterocyclic Compounds; Anilides; Amides; Aniline Compounds; Amines; Acetanilides; Piperidines; Acetaminophen; Fentanyl; dexketoprofen trometamol
• Other Study ID Numbers: KSH-ANES-2026/77

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