Genicular Nerve Blocks for Anterior Cruciate Ligament Knee Surgery

The purpose of this randomized controlled trial is to assess a new analgesia regimen that includes the addition of genicular never blocks to our current standard regimen of peripheral nerve blocks, which includes an adductor canal block (ACB) and interspace between the popliteal artery and capsule of the posterior knee block (IPACK). The main questions it aims to answer are:Does addition of genicular nerve blocks to standard peripheral block regimen significantly reduce the mean opioid consumption by 33% in the first 24 hours?Does genicular nerve blocks reduce NRS pain scores?Does genicular nerve blocks facilitate earlier discharge?Does genicular nerve blocks last longer than 24 hours?Does genicular nerve blocks improve pain management?Eligible patients are those undergoing an anterior cruciate ligament repair at the Hospital for Special Surgery and participants will be randomized to receive the intervention (genicular nerve block) or the standard of care.

Inclusion Criteria:Age 18 - 80English speakingAmerican Society of Anesthesiologists (ASA) I - IIIBMI < 35Scheduled for ambulatory arthroscopic unilateral anterior cruciate ligament repair surgery with bone tendon bone autograftExclusion Criteria:History of chronic pain syndromesChronic opioid use (daily morphine milligram equivalents > 30 mg for at least 3 months)Contraindication to peripheral nerve blocksContraindication to neuraxial anesthesiaHistory of peripheral neuropathy or pre-existing neurological deficitsPsychiatric or cognitive disorder that prohibit patient from following study protocolAllergy to local anesthetic or study medicationsMulti-ligament surgeryHistory of substance abuseInfection at the site of injection