One hundred and twenty four patients undergoing total knee arthroplasty for osteoarthritis were randomized to receive either an intra-articular adductor canal block (IA-ACB) performed by joint surgeons (n=62) or an ultrasound-guided adductor canal block (UG-ACB) performed by anesthesiologists (n=62), with both groups also receiving periarticular injections. The primary outcome was postoperative pain assessed by numeric rating scale (NRS) scores at rest and during activity. Secondary outcomes included opioid consumption, walking distance on postoperative day (POD) 3, and adverse events such as nausea, vomiting, or wound complications. Outcomes were measured at 6 hours and on PODs 1–3, with follow-up to 3 months. Overall, the results of the study revealed that both IA-ACB and UG-ACB provided comparable analgesia, though IA-ACB patients required slightly more opioids on POD 0 (p=0.048). The study concludes that IA-ACB is a safe and effective alternative to UG-ACB but may lead to a higher initial postoperative opioid requirement.