Effect of iPACK and BiFeS Blocks on Quality of Recovery After Total Knee Arthroplasty
Key facts
- Who runs it
- Ataturk University
- Where
- Türkiye1 site in 1 countryChoose a country to see its sites
- Trial code
- Status
- Completed
- People taking part
- 74 people enrolled
- Started
- 1 Dec 2025
- Ended
- 2 Oct 2026
- Type of study
- Interventional, 2 groupsOne group gets an existing treatment, for comparison.
- Treatments tested
- Adductor Canal Block (ACB) Only
- IPACK block
- BiFeS Block
- Record updated
- 5 October 2026
Who can take part
- Age
- 18 years to 75 years
- Sex
- Women and men
- Healthy volunteers
- Cannot take part
The registry criteria, word for word
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Who can take part
- Age 18-75 years
- Scheduled for elective primary unilateral total knee arthroplasty (TKA)
- Planned spinal anesthesia
- ASA physical status I-III
- Ability to understand study procedures and provide written informed consent
Who cannot take part
- Coagulopathy or current anticoagulant therapy
- Known allergy or hypersensitivity to local anesthetics or other study medications
- Severe hepatic, renal, or cardiac failure
- History of neuropathic pain
- Infection at the site of proposed nerve block
- Pre-existing neuromuscular disorders in the lower extremities
- Inability to cooperate or refusal to participate in the study
- Pregnancy
This trial has no sites in United States.
It has sites in one country. Choose a country to see its sites.
About the trial
What the trial wants to find out
This prospective, randomized, double-blind clinical trial aims to compare the effects of two different posterior knee analgesia techniques-iPACK block (Interspace Between the Popliteal Artery and the Capsule of the posterior Knee) and the Biceps Femoris Short Head (BiFeS) block-when combined with an adductor canal block (ACB) in patients undergoing elective unilateral total knee arthroplasty (TKA). Effective postoperative analgesia is essential for early mobilization, enhanced recovery, and patient satisfaction after TKA. Although ACB provides good anterior knee analgesia while preserving quadriceps strength, additional posterior knee analgesia is often required.
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The iPACK block is a commonly used technique that targets the posterior knee capsule, whereas the newer BiFeS block aims to provide more selective posterolateral sensory blockade with potentially reduced risk of motor involvement. However, comparative clinical data between these two techniques are limited.
The primary objective of this study is to evaluate the difference between the iPACK and BiFeS blocks in terms of Quality of Recovery-15 (QoR-15) scores at 24 hours postoperatively. Secondary objectives include comparisons of postoperative pain scores, opioid consumption, time to first analgesic request, quadriceps and anterior tibialis muscle strength, functional test performance, time to mobilization, active range of motion, and the incidence of adverse events.
A total of 74 adult patients scheduled for elective unilateral TKA under spinal anesthesia will be randomized in a 1:1 ratio into two groups: ACB + iPACK block or ACB + BiFeS block. All blocks will be performed under ultrasound guidance by an experienced anesthesiologist. Outcome assessments will be conducted by blinded investigators. The study aims to provide high-quality clinical evidence regarding the effectiveness of the BiFeS block compared to the widely used iPACK technique.
The 2 groups in the trial
- Adductor Canal Block + iPACK BlockExisting treatment, for comparison
Participants in this arm will receive an ultrasound-guided adductor canal block (ACB) using 15 mL of 0.25% bupivacaine, followed by an iPACK (Interspace Between the Popliteal Artery and the Capsule of the posterior Knee) block with 25 mL of 0.25% bupivacaine. Blocks will be performed under sterile ultrasound guidance by an experienced anesthesiologist who will not participate in postoperative assessments. All patients will receive standardized spinal anesthesia and perioperative analgesia.
Treatment: Adductor Canal Block (ACB) Only and IPACK block
- Adductor Canal Block + BiFeS BlockTreatment being tested
Participants in this arm will receive an ultrasound-guided adductor canal block (ACB) using 15 mL of 0.25% bupivacaine, followed by a BiFeS (Biceps Femoris Short Head) block performed by injecting 25 mL of 0.25% bupivacaine into the potential space between the femur and the short head of the biceps femoris muscle. Procedures will be performed under sterile ultrasound guidance by an anesthesiologist not involved in postoperative assessments. All participants will receive standardized spinal anesthesia and perioperative analgesia.
Treatment: Adductor Canal Block (ACB) Only and BiFeS Block
Data and sources
- Registry record
- Listed on ClinicalTrials.gov.
- Official title
- Effects of iPACK and Biceps Femoris Short Head (BiFeS) Blocks Combined With Adductor Canal Block on Quality of Recovery After Total Knee Arthroplasty: A Prospective, Randomized, Double-Blind Clinical Trial
- Record updated
- 5 October 2026