Background and Aims Motor-sparing peripheral nerve blocks, such as the infiltration between the popliteal artery and capsule of the knee (IPACK) and the adductor canal block (ACB), may augment PAI in multimodal analgesic pathways for knee surgery, but supporting literature remains rare. We hypothesized that ACB and IPACK would lower pain on ambulation on postoperative day (POD) 1 compared to PAI alone.

Methods This triple-blinded randomized controlled trial included 50 patients undergoing ACL repair. Patients either received (1) a PAI (control group, n = 26) or (2) an iPACK with an ACB (intervention group, n = 24). The primary outcome was pain on ambulation on POD 1. Secondary outcomes included numeric rating scale (NRS) pain scores, patient satisfaction, and opioid consumption.

Results The intervention group reported significantly lower NRS pain scores on ambulation than the control group on POD 1( 3.3 [2.7 to 4.0]; P <0.001). In addition, NRS pain scores on ambulation on POD 0 (3.5 [2.7 to 4.3]; P <0.001) and POD 2 (1.0 [1.0 to 1.9]; P =0.033) were significantly lower. Patients in the intervention group were more satisfied, had less opioid consumption (P =0.005, PACU, P =0.028, POD 0), less intravenous opioids (P <0.001), and reduced need for intravenous patient-controlled analgesia (P =0.037).

Conclusions The combination of iPACK to ACB significantly improves analgesia and reduces opioid consumption after ACL repair compared to PAI alone. This study strongly supports iPACK and ACB use within a multimodal analgesic pathway.