Analgesic Effect of Adductor Canal Block, IPACK Block, and Genicular Nerve Block

Adductor canal block procedure: The patient will be informed about the technique and consent will be obtained. The patient's hip will be slightly externally rotated, and an ultrasonography linear probe will be placed on the medial thigh, at the midpoint of the patella and vastus medialis. After locating the femoral artery at approximately 3-4 cm depth, if not visible, the artery can be traced distally from the inguinal region using Doppler mode. Once the vastus medialis and sartorius muscles are identified, the superficial femoral artery is centered at the midpoint of the sartorius muscle. The adductor canal roof, along with the saphenous and vastus medialis nerves, appears as hyperechoic structures. A needle is inserted in-plane, advancing toward the anterolateral femoral artery aspect, and 5-20 mL of LA is injected.

Genicular Nerve Block: The patient is informed and consent is obtained. With a pillow in the popliteal fossa, the knee is slightly flexed. For the superior lateral genicular nerve, a linear USG probe is positioned on the lateral femoral epicondyle, moving proximally to visualize the bone metaphysis. The superolateral artery is seen between the vastus lateralis fascia and the femur. Using in-plane or out-of-plane technique, the needle is guided to the bone, and 4-5 mL of LA is injected. For the superior medial nerve, the probe is placed on the medial epicondyle and moved proximally to visualize the bone near the adductor tubercle. The artery lies between the femur and vastus medialis fascia. For the inferomedial artery, the probe is placed on the tibial medial condyle, moving distally. A negative aspiration test is conducted before each LA injection.

IPACK Block: Before the procedure, the patient is informed about the technique and written consent is obtained from the patient. The patient lies in the prone position. The linear USG probe is placed approximately 2-3 cm above the popliteal fossa and scanned distally to identify the femoral shaft and popliteal artery. If the femoral condyles are initially visualized, the probe is moved until the condyles disappear and the femoral shaft is identified as a straight line and hyperechoic. Color doppler can be used to identify the popliteal vessels. The peripheral block needle is advanced between the femoral shaft and the popliteal artery. After negative aspiration control, 15-20 mL of LA medication is injected here.