Ultrasound Guided Combined Adductor Canal, Superior Genicular Nerves and Anterior Femoral Cutaneous Nerves Blocks in Comparison With Periarticular Local Anesthesia Infiltration in Primary Total Knee Arthroplasty

Background: Pain management in total knee arthroplasty continues to evolve especially as an early postoperative analgesia is of paramount importance in achieving patient satisfaction and improving clinical outcomes. The goal of achieving an ideal analgesia modality which facilitates early rehabilitation, prevents knee stiffness, reduces hospital stay due to pain, and promotes good functional outcomes continues to be elusive. Multimodal analgesia has been devised to control postoperative pain and reduce opioid consumption including periarticular injection and peripheral nerve blocks. Rationale: Assess the efficacy of a triple block including Adductor canal block, superior lateral, superior medial genicular nerves block and anterior femoral cutaneous nerves block in comparison with Periarticular infiltration for pain management in patients undergoing a total knee arthroplasty. Methods: Prospective Randomized Control Trial

Inclusion Criteria: 1. ASA: I - II 2. Gender: Male \& Female 3. Age: 18and above 4. BMI less than 40 kg/m2 5. Patients are scheduled for primary unilateral total knee arthroplasty. Exclusion Criteria: 1. Patients with contraindications to spinal anesthesia 2. Failed spinal anesthesia. 3. ASA III - IV 4. Body mass index (BMI)≥40, 5. A known allergy or contraindication to the drugs used in this study. 6. Previous surgery at the same knee 7. Renal impairment. 8. Patients who suffer from chronic neuropathic pain or on regular pain medications other than NSAIDs.