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NCT Number: NCT07418307

Comparison Between Combined Biceps Femoris Short Head Block and Adductor Canal Block Versus Genicular Nerve Block

The purpose of this study is to compare the analgesic outcomes (time to first analgesic request, total amount of analgesic consumption, and pain scores) following total knee arthroplasty by either combined biceps femoris short head block and adductor canal block or genicular nerve block in elderly patients.

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Key information

Conditions

Knee Arthroplasty, Total

Age range

65 year and older

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • patient acceptance
  • Physical status: ASA I, II and Ⅲ.
  • Body mass index (BMI): 18.5 - 35 kg/m2.
  • Type of operations: total knee arthroplasty.

Exclusion criteria

  • Known hypersensitivity to dexamethasone or bupivacaine.
  • Coagulation disorders or taking drugs affect surgical hemostasis.
  • Patients with pre-existing neurological deficits.
  • Uncooperative patient or with altered mental status.
  • Patient with advanced cardiovascular or respiratory diseases or uncontrolled diabetes

Treatment and study plan

Combined biceps femoris short head block and adductor canal block

Other

Adductor Canal Block high-frequency probe will be placed transversely on the anterior thigh midpoint between inguinal crease and medial condyle (depth 3-5 cm). The needle will be advanced in-plane from lateral to medial through sartorius or vastus medialis muscle toward the femoral artery. Then (10 ml of 0.25% bupivacaine and 2 mg dexamethasone) will be injected after negative aspiration, with confirming spread around the artery without vascular puncture.

Biceps femoris short head block The probe will be placed on the distal posterior thigh to visualize biceps femoris muscle near the lateral supracondylar line of the femur. The needle will be inserted to the interface between biceps femoris and femur cortex. Then (25 ml of 0.25% bupivacaine and 2 mg dexamethasone), with observing muscle lift and circumferential spread along the bone surface .

Genicular nerve block

Other

Position the patient will be placed in supine position with the knee slightly flexed via a pillow in the popliteal fossa. Use a high-frequency linear ultrasound transducer.

Superolateral genicular nerve (SLGN): the transducer will be placed coronally over lateral femoral epicondyle, with sliding proximally to femur metaphysis; identifying artery between vastus lateralis fascia and bone.

Superomedial genicular nerve (SMGN): the transducer will be placed coronally over medial femoral epicondyle, proximal to adductor tubercle at femur metaphysis; artery between vastus medialis fascia and bone.

Inferomedial genicular nerve (IMGN): the transducer will be placed coronally over medial tibial condyle, distal to metaphysis; artery beneath medial collateral ligament.

  • Inferolateral genicular nerve (ILGN, optional): the transducer will be placed coronally over lateral tibial epicondyle to fibula head; artery between collateral ligament and tibia

Primary outcomes

  1. Time of first rescue analgesia (naluphine)

    Time frame: 24 hours postoperative

    to the duration from the block to the moment when the patient first requires or requests supplemental nalbuphine due to breakthrough pain

Secondary outcomes

  1. block performance time

    Time frame: time of performance of the block

    time refers to the duration required to prepare, image (e.g., via ultrasound), insert the needle, and inject local anesthetic to complete a regional nerve block procedure.

  2. Pain intensity

    Time frame: 30 minutesn2, 4, 8, 12, 18 , and 24 hours postoperative

    10-point NRS [(0 = no pain, 10 = worst imaginable pain), 1-3: Mild pain (nagging, annoying, slightly interfering with activities of daily living (ADLs), 4 - 6: Moderate pain (significantly interfering with ADLs, 7 - 10: Severe pain (disabling, unable to perform ADLs)

  3. Total amount of rescue analgesia (nalbuphine)

    Time frame: first 24 hours postoperative

    the cumulative dose of nalbuphine administered as supplemental pain relief during a defined postoperative observation period, typically when pain scores exceed a predefined threshold like NRS ≥4

  4. assess functional recovery

    Time frame: at 12 hours and 24 hours postoperative

    (knee range of motion active flexion /extension,

  5. patient's satisfaction

    Time frame: 24 hours postoperative

    The patients will be asked to rate the overall degree of satisfaction of the analgesia by using a 5-points likert-like verbal scale (1 = very dissatisfied analgesia, 2 = dissatisfied analgesia, and 3 = neutral, 4=satisfied analgesia, and 5=very satisfied analgesia)

  6. Block related complications

    Time frame: 24 hours postoperative

    (motor weakness, hematoma, local anesthetic toxicity,..)

Study contacts

Contact information is provided by the study sponsor or research team.

Howida A Kamal, M.D

CONTACT

[email protected]

01225096755

Marwa M Medhat, M.D

CONTACT

[email protected]

01002828937

Sponsors and collaborators

Lead sponsor

Zagazig University

Other Gov

Registry information

Official study title

Enhanced Analgesia in Elderly After Total Knee Arthroplasty Using Combined Biceps Femoris Short Head Block and Adductor Canal Block Versus Genicular Nerve Block

Important dates

Study start
2026
Primary completion
2026
Study completion
2026
First posted
Feb 18, 2026
Registry last updated
Feb 18, 2026

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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