NCT07478783

Genicular Nerve Block Added to Femoral Nerve Block for Analgesia After Total Knee Arthroplasty

Addition Of Genicular Nerve Block To Femoral Nerve Block Improves Early Postoperative Analgesia After Total Knee Replacement: A Randomized Controlled Trial

• Status: Completed
• Phase: N/A
• Study type: Interventional
• Enrollment: 80 (actual)
• Sponsor: Ankara City Hospital Bilkent · Academic / Other
• Sex: All
• Age: 18 Years – 80 Years
• Healthy volunteers: Not accepted

Summary

Total knee arthroplasty (TKA) is a common orthopedic procedure in which effective postoperative pain management is important for early mobilization and rehabilitation. Various regional anesthesia techniques are used as part of multimodal analgesia protocols to improve postoperative pain control. Genicular nerve block has recently been introduced as a potential motor-sparing technique that may enhance postoperative analgesia when used alone or in combination with other regional blocks. The aim of this randomized controlled study is to evaluate whether the addition of ultrasound-guided genicular nerve block to femoral nerve block improves early postoperative analgesia in patients undergoing primary unilateral total knee arthroplasty under combined spinal-epidural anesthesia. A total of 80 patients aged 18-80 years scheduled for elective primary unilateral TKA will be included and randomly assigned to two groups using sealed envelopes. One group will receive femoral nerve block alone (Group F), while the other group will receive femoral nerve block combined with genicular nerve block (Group FG). Postoperative pain scores using the visual analog scale (VAS), epidural patient-controlled analgesia consumption during the first 24 hours, and the time to additional analgesic requirement will be recorded and compared between the groups.

Detailed description

The aim of this prospective, randomized controlled study is to evaluate whether the addition of an ultrasound-guided (USG) genicular nerve block (GNB) to a standard femoral nerve block (FNB) improves postoperative analgesia compared with FNB alone in patients undergoing primary unilateral total knee arthroplasty (TKA). All patients will undergo surgery under combined spinal-epidural anesthesia. After administration of the spinal block and placement of the epidural catheter, participants will be randomly assigned to one of two groups. Group F (Control): Participants will receive an ultrasound-guided femoral nerve block using 20 mL of 0.25% bupivacaine. Group FG (Intervention): Participants will receive an ultrasound-guided femoral nerve block (20 mL of 0.25% bupivacaine) combined with a four-point ultrasound-guided genicular nerve block targeting the superomedial, superolateral, inferomedial, and inferolateral genicular nerve branches. Each branch will receive 5 mL of 0.25% bupivacaine. Postoperative analgesia will be standardized in both groups using an epidural patient-controlled analgesia (PCA) device operating in bolus-only mode (5 mL bolus, 20-minute lockout interval) containing fentanyl (3 µg/mL) and bupivacaine (0.5 mg/mL). The primary outcome measure will be the total volume of epidural analgesic solution consumed during the first 24 hours after surgery. Secondary outcome measures will include postoperative pain intensity assessed using the Visual Analog Scale (VAS) at predefined time points (0, 2, 8, 12, and 24 hours), time to first additional analgesic requirement, and the incidence of postoperative side effects such as nausea or dizziness.

Conditions

• Total Knee Anthroplasty

Interventions

Type	Name	Description
PROCEDURE	Ultrasound-guided Femoral Nerve Block	Administration of 20 ml of 0.25% bupivacaine to the femoral nerve under ultrasound guidance. This procedure was performed on patients in both Group F and Group FG
PROCEDURE	ltrasound-guided Genicular Nerve Block	Administration of 5 ml of 0.25% bupivacaine to each of the four genicular nerve branches (superomedial, superolateral, inferomedial, and inferolateral) under ultrasound guidance. This procedure was performed only on patients in Group FG

Timeline

• Start date: 2021-11-01
• Primary completion: 2021-11-01
• Completion: 2022-02-28
• First posted: 2026-03-18
• Last updated: 2026-03-25

Locations

2 sites across 1 country: Turkey (Türkiye)