About this trial
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.
Eligibility criteria
This trial accepts healthy volunteersQualifiers
Patients aged 18 and older
ASA I-III
Patients scheduled for elective unilateral knee replacement
Eligibility for and consent to spinal anesthesia
Disqualifiers
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
Trial design
Parallel
Treatments tested in this trial
Procedure: Biceps Femoris Short Head Block
Procedure/SurgeryPatients 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.
Procedure: Spinal Anesthesia
Procedure/SurgeryPatients 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.
Treatment groups
Trial outcomes
Primary outcomes
Total Morphine Consumption in 24 Hours
Total cumulative morphine consumption measured from patient-controlled analgesia device during the first 24 postoperative hours.
Secondary outcomes
Numeric Rating Scale (NRS) Pain Scores
Pain intensity measured using NRS at rest (0-10 scale).
Time to First Analgesic Requirement
Time from end of surgery to first patient-reported pain requiring analgesic medication.
Time to First Foot Movement
Time from completion of surgery to first active foot movement.
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.
Sponsors and contacts
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Ömer Kayar
Lead sponsor
Kayseri City Hospital
Sponsor institution