One hundred forty patients undergoing total knee arthroplasty were randomized to receive either intraoperative landmark-based genicular nerve block (n=69) or periarticular infiltration (n=70). The primary outcome was pain scores at rest and during movement at 12 hours postoperatively using an 11-point Numerical Rating Scale. Secondary outcomes included morphine consumption, time to rescue analgesia, functional performance, and muscle strength. Outcomes were assessed up to 48 hours postoperatively. Overall, the study found that GNB provided non-inferior pain relief at rest but not during movement. Morphine consumption was higher, and time to rescue analgesia was shorter in the GNB group. These findings suggest that while both techniques are effective, PAI may offer slight advantages in dynamic pain management and opioid consumption.