Comparing Two Types of Nerve Blocks for Pain Relief After Total Knee Replacement Surgery

What this Trial Is About

Total knee arthroplasty TKA is performed for severe knee conditions but often causes intense pain after surgery, which can delay movement, extend hospital stays, and lower patient satisfaction. Researchers are studying two combinations of regional nerve blocks to manage this pain better while preserving muscle strength the adductor canal block ACB with IPACK block and ACB with Biceps Femoris Short Head BiFeS block. This study is prospective, randomized, and aims to compare the effectiveness of these two approaches in controlling postoperative pain under spinal anesthesia. Participants will be divided into two groups receiving ultrasound-guided nerve blocks. One group will get ACB combined with IPACK block, while the other will receive ACB combined with BiFeS block, both using specific doses of bupivacaine. All patients will also receive spinal anesthesia during surgery. The study includes standardized postoperative pain management with paracetamol and patient-controlled tramadol, with rescue fentanyl available as needed. Pain scores and opioid use will be tracked at multiple time points during the first 24 hours after surgery. Participants will undergo regular assessments including pain ratings at rest and movement, muscle strength tests, and monitoring of side effects like nausea and vomiting. Researchers will also record recovery quality, vital signs, time to first mobility, and bowel function. The primary outcome is total opioid consumption in the first 24 hours, with additional measures such as time to first mobilization and motor block incidence. The study will last through the immediate postoperative period with careful monitoring and safety criteria to stop participation if severe pain occurs.

Comparing ACB+IPACK and ACB+BiFeS Block Combinations for Analgesia in Total Knee Arthroplasty