Two hundred forty patients undergoing total knee arthroplasty (TKA) for osteoarthritis were randomized into three groups: adductor canal block by surgeon (ACBs, n=80), ultrasound-guided adductor canal block by anesthesiologist (ACBa, n=80), or no block (control, n=80). The primary outcome was postoperative pain as assessed by the Visual Analog Scale (VAS). Secondary outcomes included opioid consumption, range of motion, and functional scores. Pain scores were measured at multiple time points, including 3 hours, 12 hours, and 12 weeks postoperatively, with opioid usage monitored for the first three days. Overall, the ACBa group demonstrated significantly lower VAS scores and opioid use in the immediate postoperative period compared to the other groups, with no significant difference observed in functional outcomes at 12 weeks. These findings suggest that ultrasound-guided ACB provides effective short-term pain relief and reduces opioid requirements without affecting long-term recovery.