Comparison of Sciatic, BiFeS, and IPACK Blocks Added to the Adductor Canal Block for Postoperative Pain Control in Primary Total Knee Arthroplasty: A Randomized Controlled Trial

What this Trial Is About

Postoperative pain after total knee arthroplasty (TKA) can delay recovery, lower patient satisfaction, and increase the need for pain medicine. Researchers are studying three nerve block techniques—sciatic nerve block, Biceps Femoris Short Head (BiFeS) block, and Interspace Between the Popliteal Artery and the Capsule of the posterior Knee (IPACK) block—to see which works best when added to the commonly used adductor canal block. The goal is to find the optimal combination to control pain while preserving leg movement and improving patient satisfaction. This research is a prospective, double-blind, randomized controlled trial including at least 102 adults aged 18 to 75 scheduled for elective unilateral primary TKA. Patients are randomly assigned to receive one of three combinations: adductor canal block plus sciatic nerve block, adductor canal block plus BiFeS block, or adductor canal block plus IPACK block. All nerve blocks use ultrasound guidance and a mixture of local anesthetics. Surgery is performed under spinal anesthesia, and all blocks are done by an experienced anesthesiologist. Participants will be closely monitored during and after surgery. Pain levels will be measured using a visual analog scale at several points within 24 hours postoperatively. Motor function, opioid use, and patient recovery quality will also be assessed. Standard pain medications are given, with tramadol as rescue medication if needed. Data collectors and outcome assessors remain blinded to the treatment groups. The study will run over a 12-month period starting November 2025.

Supplementary Nerve Blocks Added to the Adductor Canal Block for Postoperative Pain Management in Primary Total Knee Arthroplasty: A Randomized Controlled Comparison of Sciatic, BiFeS, and IPACK Techniques