This study evaluates the analgesic efficacy and motor-sparing properties of ultrasound-guided Suprainguinal Fascia Iliaca Block (S-FIB) compared with Adductor Canal Block (ACB) in patients undergoing primary total knee arthroplasty (TKA). The main hypothesis is that ACB better preserves quadriceps muscle strength, allowing earlier functional mobilization, while providing comparable (non-inferior) analgesia to S-FIB.
ASA Physical Status I, II, or III
Scheduled for elective unilateral primary total knee arthroplasty
Able to understand and operate the PCA device
Written informed consent provided
Pre-existing lower-extremity neurological deficit or motor weakness (e.g., severe diabetic neuropathy)
Chronic opioid use (>30 mg oral morphine equivalents/day for >3 months)
Infection at the block site or systemic sepsis
Coagulopathy or bleeding diathesis
Parallel
PCA
DrugAll patients receive standardized spinal anesthesia and postoperative intravenous PCA tramadol within a standardized multimodal regimen.
Postoperative Pain Intensity (NRS)
Numerical Rating Scale (0-10) at rest and during active knee flexion (30°). Time Frame: Postoperative hours 2, 6, 12, 24, and 48.
Quadriceps Muscle Strength
Active Straight Leg Raise (SLR) Angle Maximum hip flexion angle (degrees, 0-90°) achieved during an active straight leg raise in the supine position, measured with a digital clinometer/goniometer.
Cumulative Opioid Consumption
Total IV tramadol delivered via PCA (patient controlled analgesia).
Time to First Mobilization
Hours from end of surgery to first assisted/unassisted ambulation
Quality of Recovery (QoR-15)
Validated 15-item questionnaire (0-150; higher = better recovery).
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