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Please confirm that an ethics committee approval has been applied for or granted: Yes: I’m uploading the Ethics Committee Approval as a PDF file with this abstract submissionApplication for ESRA Abstract PrizesBackground and Aims Despite proven efficacy in knee arthroplasty, the role of adductor canal block (ACB) and the infiltration between the popliteal artery and posterior capsule of the knee (iPACK) block in managing pain and improving function after anterior cruciate ligament (ACL) reconstruction is not yet well defined. This randomized controlled trial aimed to determine whether ACB combined with iPACK block offers superior postoperative analgesia compared to ACB alone.Methods After ethical approval 54 consenting patients undergoing ACL reconstruction under spinal anesthesia were randomly received either ACB with iPACK block (Group-I) or ACB alone (Group-C). The primary outcome was pain intensity at rest at six hour postoperatively, measured using a numerical rating scale (NRS,0–10). Pain at 12, 18, and 24 hours postoperatively, total morphine consumption in the first 24 hours after surgery, patient satisfaction and postoperative functional outcomes including Lysholm score and International Knee Documentation Committee (IKDC) score up to 1 year later were secondary outcomes.Results Baseline characteristics were similar between groups ( table 1). At 6 hours, pain scores at rest were not significantly different (median NRS: Group-I, 0 [0–1] vs. Group-C, 2 [0–3]; p = 0.053). However, Group-I demonstrated significantly lower pain scores at rest and with movement at subsequent time points (table 2). No significant differences were observed in morphine use, satisfaction, or functional outcome scores (table 3).Abstract P309 Table 1Demographic data. Data are presented as mean±SD or median [interquatile range] depending on the distribution of data and frequency, n (%). ASA, American Society of Anesthesiologists; BMI, body mass indexAbstract P309 Table 2Clinical parameters and variable outcomes. Data are presented as median [interquatile range] and n (%). NRS, numerical rating scaleAbstract P309 Table 3Functional outcomes including Lysholm knee score and IKDC score. IDKC, International Knee Documentation CommitteeConclusions While combining ACB with iPACK block improved analgesia at later stages following ACL reconstruction, overall pain levels were mild in both groups, and differences may have limited clinical significance.