Evaluation of the Role of Genicular Nerve Block When Combined With Adductor Canal Block for Pain Control Following Knee Arthroscopy

All patients will receive adductor canal block under complete aseptic conditions using a high-frequency ultrasound guidance (Sonosite turbo M, Bothell, Washington,USA ). while patient is laying supine lower limbs will slightly abducted at the hips and flexed at the knees , using linear ultrasound probe(2.5-7.5MHZ) on the anterior aspect of the patient's thigh, At the level of mid-thigh, by moving probe medially until the boat shaped Sartorius muscle is visualized , at which the adductor canal is identified beneath the sartorius muscle, 20ml bupivacaine (0.25%) will be injected in the canal after a careful negative aspiration. The spread of the drug lateral and around the femoral artery will be seen real time on ultrasound

All patients will receive adductor canal block as described above under complete aseptic conditions then they will receive the genicular nerve block using a high-frequency ultrasound guidance (Sonosite turbo M, Bothell, Washington,USA ), genicular nerve block will be done at three locations, i.e., superomedial, superolateral, and inferomedial locations of the condyle-shaft junction, while patient is lying supine linear ultrasound probe(2.5-7.5MHZ) will be used to target the superomedial, superolateral, and inferomedial genicular nerves,2ml bupivacaine (0.25%) will be injected in the 3 mentioned points after a careful negative aspiration