The aim of this study is to investigate the effectiveness of combined adductor canal block (ACB) with interspace between popliteal artery and the knee capsule (IPACK) versus combined ACB with genicular nerve block (GNB) for providing analgesia in knee arthroplasty. The investigators hypothesize that the analgesic efficacy of ACB combined with GNB will be non-inferior to that of ACB combined with IPACK. Additionally, the investigators aim to assess whether the combination of ACB and GNB results in a significantly lower occurrence of sensory or motor block affecting the tibial and common peroneal nerves compared to ACB and IPACK
Patients American Society of anesthesiologists' physical status (ASA) I to III.
Aged 18 to 70 years.
Both sexes.
Patients scheduled for total knee arthroplasty.
Patient refusal
ASA physical status IV or more.
Patients with known allergy to any of the study drugs.
Infection at the site of injection.
Parallel
nerve block with bupivacaine 0.25%
Drugultrasound guided adductor canal block and interspace between the popliteal artery and the knee capsule using bupivacaine 0.25%
Nerve Block with bupivacaine 0.25%
Drugultrasound guided combined adductor canal block and genicular nerve block using bupivacaine 0.25%
individual visual analog pain scores at 0, 6, 12 , 24 and 48 h postoperatively
(VAS; 0 = no pain and 10 = worst pain imaginable)
time to first reported pain and first analgesic request during post-anesthesia care unit stay
reported time in minutes
Analgesic consumption during the first 48 h post-surgery
Converted to IV pethidine equivalents. The analgesic dose of pethidine will be 0.5 mg/kg/dose to be repeated on demand
Quadriceps muscle strength
will be measured using the Straight Leg Raise (SLR) test, which will be conducted preoperatively and again 24 hours postoperatively. The SLR will be scored on a scale from 0 to 5, where 0 indicates no voluntary contraction, 1 signifies muscle flicker without limb movement, 2 represents active movement with gravity eliminated, 3 indicates movement against gravity but without resistance, 4 denotes movement against some resistance, and 5 reflects normal motor strength against resistance.
The sensorimotor functions of the tibial nerve and common peroneal nerve (CPN) will be evaluated using a 3-point scale
For sensory function, the scale will be as follows: 0 indicates normal sensation, 1 signifies lack of cold perception but intact touch sensation, and 2 denotes absence of touch sensation. For motor function, the scale will be: 0 for normal motor function, 1 for deficient motor function, and 2 for no motor function.
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