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Abstract : Total knee arthroplasty is a painful procedure that requires a multimodal analgesia for pain relief. Adductor canal block (ACB) combined with ultrasound-guided local anesthetic infiltration of the interspaces between popliteal artery and the capsule of posterior knee (IPACK) providing significant knee joint analgesia without hamper motor function. This prospective comparative study aimed to evaluate the efficiency and safety of adductor canal block (ACB) combined with local anesthetic infiltration between popliteal artery and posterior knee capsule (IPACK block) versus adductor canal block (ACB) combined with Tramadol in pain control after total knee arthroplasty (TKA). This prospective study was carried out in the orthopedic theatre of Al Basra Teaching Hospital. Sixty patients were divided into two groups with 30 patients in each one, group A (ACB + IPACK block) patients with odd number while group B (ACB + Tramadol) patients with even number. All patients were evaluated with VAS and satisfaction scale recorded at the first 8 h at rest and movement after the surgery. The patient outcome parameter was assessed by presences of nausea, vomiting, hemodynamic parameters& needs of I.V opioid consumption during the first 8h postoperatively. ACB + ipack block could significantly lowered VAS, improved patient satisfaction scale, decrease the incidence of nausea and vomiting and significantly reduced I. V opioid consumption during the 1st 8h postoperative TKA compared to ACB + Tramadol. The ACB + IPACK block provide excellent analgesia of the knee joint with preservation of quadriceps muscle function beside reduces opioid consumption after total knee arthroplasty compared to ACB + Tramadol allowing for early rehabilitation and discharge.

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