Comparison Between Two Blocks in Analgesia After Knee Arthroplasty

Comparative Study Between Adductor Canal Block Combined With (IPACK) Block Versus Genicular Nerves Block Combined With (IPACK) Block Regarding Postoperative Analgesic Effect After Knee Replacement Surgery.

Comparative Study between Adductor canal block combined with infiltration OF The interspace between popliteal artery and the capsule of the knee block versus genicular nerves Block combined with IPACK in Postoperative analgesia after knee replacement surgery

Patient informed written consent and ethical committee approval of Faculty of Medicine; Ain Shams University will be obtained before patient allocation.

• Study procedures: Supervisors and experts will do all the study procedures.

Patients undergoing unilateral Total knee replacement (TKR) will be randomly assigned into one of the following groups using computer generated codes (15 patients in each group):

Group 1 (ACB - IPACK group): will receive spinal anesthesia and ultrasound-guided Adductor canal nerve block, as well as infiltration of the space between the popliteal artery and the capsule of the posterior knee (IPACK) block.

Group 2 (GNB - IPACK group): will recieve spinal anesthesia and US guided Genicular nerves block and IPACK block.

Inclusion Criteria:

• Age 30-85 years.
• Both sexes.
• American Society of Anesthesiologists (ASA) Physical Status Class I to III.
• Patients scheduled for unilateral TKA under spinal anesthesia.

Exclusion Criteria:

• Patient's refusal.
• American Society of Anesthesiologists (ASA) Physical Status Class above III.
• local infection.
• History of allergy to the medications used in the study. 5. Psychiatric disorder.