الفهرس 
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Abstract
When a noxious stimulus produces tissue injury, chemical mediators are released and activate nociceptors which in turn generate nerve impulses.
Uncontrolled postoperative pain has an adverse sequel of delayed resumption of normal pulmonary function, restriction of mobility, nausea and vomiting, increase in the systemic vascular resistance, cardiac work, and myocardial oxygen consumption through an increase in the catecholamine release induced by the stress response.
Surgeries of the knee are associated with moderate to severe postoperative pain, so these procedures are better to be done under regional anesthetic techniques which reduce neuroendocrinal stress responses, central sensitization of the nervous system and muscle spasms which occur in response to painful stimuli.
Recently, among these regional anesthetic techniques adductor canal block is gaining popularity because they reduce the possibility of complications and side effects associated with the central blocks. Adductor canal block provides effective analgesia and anesthesia with potentially fewer complications and side effects than epidural blocks. The purpose of this study was to compare between Adductor canal block and PCA in adult patients undergoing total knee replacement including comparison of analgesic efficacy, side-effects, and complications.
The study was performed upon 60 patients, and randomly distributed among two groups:
• group I: (n=30):
Patients of this group underwent ultrasound guided single shot adductor canal block after the end of surgery with 20 ml of bupivacaine 0.5%
• group II: (n=30):
Patients of this group will receive intravenous patient-controlled analgesia (PCA) with Nalbuphine.
For each patient, the following data were collected: age, sex, weight, height, ASA, hemodynamic changes, pain scores, extradoses Nalbuphine consumption, Side effects such as nausea, vomiting, pruritus, urinary retention and hypotension will be recorded. Orthopedic rehabilitation indices will be assessed by physiotherapy staff.
The results showed that the analgesia for the first 6 hours ACB is more than efficient but for the first 24 hours PCA with opioids is superior.