ACB plus IPACK versus ACB plus BiFeS blocks for pain control after total knee replacement

Comparison of Analgesic Efficacy of Infiltration Between the Popliteal Artery and Capsule of the Knee (IPACK) Versus Biceps Femoris Short Head Block Combined With Adductor Canal Block in Total Knee Arthroplasty

This trial will test whether adding an IPACK or a BiFeS block to an adductor canal block gives better pain relief for adults (18–80) having primary total knee replacement under spinal anesthesia.

Quick facts

• Phase: NA
• Study type: Interventional
• Enrollment: 78 (estimated)
• Ages: 18 Years to 80 Years
• Sex: All
• Sponsor: Hitit University (other)
• Locations: 1 site (Çorum, Centre)
• Trial ID: NCT07561333 on ClinicalTrials.gov

What this trial studies

This prospective, randomized study will compare two ultrasound-guided regional anesthesia combinations—adductor canal block (ACB) with IPACK versus ACB with Biceps Femoris Short Head (BiFeS) block—in patients undergoing primary total knee arthroplasty. Ninety-eight patients will be randomized into two groups (n=39 each) and receive blocks under spinal anesthesia, with standardized perioperative care. Primary outcomes include numeric rating scale (NRS) pain scores at rest and measures of opioid consumption and early mobilization. The trial is conducted at Hitit University and enrolls adults aged 18–80 with ASA I–III and BMI ≤35.

Who should consider this trial

Good fit: Ideal candidates are adults 18–80 years old, ASA I–III, BMI ≤35, scheduled for primary unilateral total knee arthroplasty, able to consent and to report NRS pain scores.

Not a fit: Patients undergoing revision or bilateral TKA, those with diabetes, neuromuscular or peripheral nerve disease, coagulation disorders, current anticoagulant use, pregnancy, very high opioid use, or other listed exclusions are not eligible and unlikely to benefit from this protocol.

Why it matters

Potential benefit: If successful, one block combination could provide better posterior-knee pain control, reduce opioid use, and speed early mobilization after total knee replacement.

How similar studies have performed: Previous studies have shown that adding IPACK to ACB can reduce posterior-knee pain and opioid requirements after TKA, while the BiFeS block is a newer technique with limited but promising early reports.

Eligibility criteria

Inclusion Criteria:

* Scheduled for primary total knee arthroplasty surgery
* ASA physical status classification I-III
* Hemodynamically stable
* Age ≥ 18 years and ≤ 80 years
* BMI ≤ 35 kg/m²
* Signed written informed consent form

Exclusion Criteria:

* Revision total knee arthroplasty surgery
* Simultaneous bilateral total knee arthroplasty
* BMI \> 40 kg/m²
* ASA physical status classification 4-5
* Inability to perform NRS pain scoring
* Known allergy to local anesthetics
* Pregnancy or breastfeeding
* Age \< 18 or \> 80 years
* Uncontrolled anxiety disorder
* Alcohol or drug dependency
* Neuromuscular disease or peripheral nerve disease
* High-dose opioid use within 3 days prior to surgery
* Widespread chronic pain syndrome
* Diabetes mellitus
* Hepatic or renal insufficiency
* Coagulation disorders
* Current use of anticoagulant medications
* Infection at the peripheral nerve block needle insertion site
* Refusal to participate in the study

Where this trial is running

Çorum, Centre

• Hitit University — Çorum, Centre, Turkey (Türkiye) (RECRUITING)

Study contacts

• Study coordinator: Merve YAGIZ BALDIRAN, MD

Conditions: Postoperative Pain, Total Knee Arthroplasty, Total knee arthroplasty, Regional anesthesia