Ninety-four patients undergoing total knee arthroplasty for osteoarthritis were randomized to receive either active periarticular injection (n=47) or saline placebo injection (n=47) in the context of a multimodal analgesic protocol incorporating ACB and IPACK blocks. The primary outcome was numeric rating scale (NRS) pain with ambulation on postoperative day 1. Secondary outcomes included pain at rest, opioid consumption, side effects, quality of recovery, satisfaction, and chronic pain at 3 months. Outcomes were assessed up to 3 months postoperatively. Overall, the results revealed that active PAI did not show significant superiority over saline PAI for the primary or secondary outcomes. Both groups had similar pain levels, opioid usage, and satisfaction scores, suggesting that omitting PAI may not worsen outcomes when ACB and IPACK blocks are used.