Liposomal Bupivacaine Versus Ropivacaine With Perineural Dexamethasone or Dexmedetomidine as Adjuncts for Adductor Canal Block Combined With IPACK Block in Total Knee Arthroplasty

Exclusion Criteria

• •Known allergy or contraindication to local anesthetics (bupivacaine, ropivacaine), dexamethasone, dexmedetomidine, or opioids
• •Infection at the injection site
• •Coagulopathy or current use of anticoagulants
• •Severe cardiovascular disease (New York Heart Association \[NYHA\] functional class III or IV, or recent myocardial infarction within 6 months)
• •Severe hepatic impairment (Child-Pugh class C) or renal impairment (estimated glomerular filtration rate \[eGFR\] \< 30 mL/min/1.73 m²)
• •Uncontrolled hypertension (systolic blood pressure \> 180 mmHg or diastolic blood pressure \> 110 mmHg despite medical therapy)
• •Uncontrolled diabetes mellitus (HbA1c \> 8.5%)
• •Bilateral TKA or revision TKA
• •Chronic opioid use (daily opioid consumption for \> 3 months prior to surgery)
• •Participation in another interventional clinical trial within 30 days prior to enrollment
• •Inability to communicate with study personnel or complete pain assessments (e.g., language barrier, cognitive impairment)