Background: Total knee arthroplasty (TKA) is frequently associated with significant postoperative pain, which can impede early mobilization and functional recovery. Multimodal analgesia using motor-sparing regional anesthesia techniques has become central to postoperative pain management. Adductor canal block (ACB) provides effective anterior knee analgesia while preserving quadriceps strength; however, posterior knee pain may persist. The IPACK (Interspace Between the Popliteal Artery and Capsule of the Posterior Knee) block and periarticular injection (PAI) are commonly used adjuncts to address this limitation, but comparative evidence between these two approaches remains limited. Aim: To compare the analgesic efficacy of adductor canal block combined with IPACK block versus adductor canal block combined with periarticular injection in patients undergoing unilateral total knee arthroplasty. Methods: This prospective, randomized, double-blinded clinical study was conducted at the Department of Anaesthesiology, Sree Mookambika College of Medical Sciences, from September 2024 to December 2025. Sixty patients of ASA physical status I–III scheduled for elective unilateral TKA were randomized into two groups: Group A received ACB with IPACK block, and Group B received ACB with periarticular injection. All patients underwent surgery under standardized spinal anesthesia. Postoperative pain was assessed using the Numerical Rating Scale at predefined intervals. Time to first rescue analgesic, total opioid consumption within 24 hours, early mobilization, and adverse effects were recorded. Statistical analysis was performed using SPSS software, with p < 0.05 considered statistically significant. Results: Patients in the ACB + IPACK group demonstrated significantly lower postoperative pain scores, particularly during movement, compared to the ACB + PAI group. Total opioid consumption and time to first rescue analgesic requirement were significantly reduced in Group A. Early mobilization and participation in physiotherapy were better in the ACB + IPACK group. The incidence of adverse effects was comparable between the two groups, with no significant motor weakness or block-related complications observed. Conclusion: The combination of adductor canal block with IPACK block provides superior postoperative analgesia compared to adductor canal block with periarticular injection in patients undergoing unilateral total knee arthroplasty. Improved pain control, reduced opioid consumption, and enhanced early functional recovery support the use of ACB with IPACK block as an effective component of multimodal analgesia for TKA.

Total knee arthroplasty; Adductor canal block; IPACK block; Periarticular injection; Postoperative analgesia.