Adductor Canal Block With IPCAK Versus 4-in-1 Block for Postoperative Analgesia in Knee Surgery

This randomized interventional study compares the analgesic efficacy of Adductor Canal Block combined with Infiltration of the Posterior Capsule of the Knee (IPCAK) versus the 4-in-1 block technique in patients undergoing knee surgery. Twenty-four patients were randomly allocated into two equal groups. The primary objective is to compare postoperative pain scores and analgesic requirements. Secondary outcomes include time to first rescue analgesia, total analgesic consumption, motor function preservation, and block-related complications.

Inclusion Criteria: * 1\. Patients or caregivers acceptance. 2. Age : 21 - 64 years 3. Sex : both ( males \& females). 4. Physical status: ASA І \& II. 5. BMI 18.5-30 kg/m2. 6. Type of operations : elective surgery. 7. Type of anesthesia: unilateral intrathecal anesthesia. 8. Patients undergoing elective knee surgery under unilateral spinal anesthesia 9. Duration of surgery within 2 hr. Exclusion Criteria: * Known history of allergy to study drug Coagulopathies or taking drugs affecting coagulation.. Contraindications for peripheral nerve block (PNB) and spinal anesthesia (SA) (coagulation defects, infection at the puncture site), bone degenerative disease and posttraumatic condition of the spine, dementia and severe visual or auditory disorder. Current severe psychiatric disease, alcoholism or drug dependence. Subjects with history previous knee surgery, osteoarthritis, malformation or tumors (including Baker's cyst), which could alter the normal anatomy of the popliteal fossa