{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T11:18:39Z","timestamp":1781608719759,"version":"3.54.5"},"reference-count":20,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,2,15]],"date-time":"2026-02-15T00:00:00Z","timestamp":1771113600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Total knee arthroplasty (TKA) is associated with severe postoperative pain that can impair early mobilization and prolong recovery. While adductor canal block combined with iPACK is commonly recommended, this strategy may provide incomplete articular coverage and occasionally compromise quadriceps function. Genicular nerve block (GNB) selectively targets the sensory innervation of the knee, and when combined with iPACK may achieve near-complete joint analgesia while preserving motor function. This case series aimed to evaluate the magnitude and duration of analgesia and functional recovery provided by a four-nerve GNB combined with iPACK. Methods: Five patients undergoing unilateral TKA under spinal anesthesia received ultrasound-guided blocks of the superolateral, superomedial, inferomedial genicular nerves and the nerve to vastus intermedius, together with an iPACK block. Ropivacaine combined with dexamethasone and dexmedetomidine was used. The primary outcome (pain intensity) [Numeric Rating Scale, NRS] and secondary outcomes (time to first rescue analgesia, opioid consumption, range of motion, and complications) were recorded up to 72 h postoperatively within a standardized multimodal analgesic protocol. Results: Pain scores at rest and on movement remained consistently below 3\/10 in all patients. Three patients required no rescue analgesia, while two required a single dose at 36\u201340 h. Knee range of motion exceeded 90\u00b0 in all cases, and early mobilization was achieved without quadriceps weakness. No neurological or systemic adverse events occurred. Conclusions: Four-nerve genicular block combined with iPACK, enhanced with perineural adjuncts, provided prolonged, opioid-sparing analgesia with preserved motor function after TKA. This joint-selective, motor-sparing strategy warrants further evaluation in randomized trials.<\/jats:p>","DOI":"10.3390\/jcm15041546","type":"journal-article","created":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T08:38:39Z","timestamp":1771231119000},"page":"1546","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["A Preliminary Observational Case Series of Combined Genicular Nerve Block and iPACK for Total Knee Arthroplasty"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-4132-5596","authenticated-orcid":false,"given":"Francesco","family":"Tasso","sequence":"first","affiliation":[{"name":"IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3614-0892","authenticated-orcid":false,"given":"Giuseppe","family":"Monteleone","sequence":"additional","affiliation":[{"name":"IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0840-9180","authenticated-orcid":false,"given":"Francesco","family":"Marrone","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care, Santo Spirito Hospital, 00193 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danilo","family":"Esposito","sequence":"additional","affiliation":[{"name":"IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emilia","family":"Cialdella","sequence":"additional","affiliation":[{"name":"IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6342-2740","authenticated-orcid":false,"given":"Marco","family":"Minelli","sequence":"additional","affiliation":[{"name":"IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy"},{"name":"Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Scrivano","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Sant\u2019Andrea Hospital, \u201cSapienza\u201d University of Rome, 00189 Rome, Italy"},{"name":"Department of Orthopaedic Surgery, Santo Spirito Hospital, 00193 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6776-1830","authenticated-orcid":false,"given":"Marco","family":"Scardino","sequence":"additional","affiliation":[{"name":"IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"566","DOI":"10.1016\/j.pain.2010.11.023","article-title":"Persistent pain after joint replacement: Prevalence, sensory qualities, and postoperative determinants","volume":"152","author":"Wylde","year":"2011","journal-title":"Pain"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"743","DOI":"10.1097\/EJA.0000000000001691","article-title":"Pain management after total knee arthroplasty: PROcedure SPEcific Postoperative Pain Management recommendations","volume":"39","author":"Kehlet","year":"2022","journal-title":"Eur. 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