Combined adductor canal (ACB) and sacral erector spinae plane (S-ESP) blocks for total knee arthroplasty pain in hemophilic arthropathy

We present the case of a successful application of combined adductor canal block (ACB) and sacral erector spinae plane (S-ESP) block for the management of a patient suffering from severe hemophilia A with an end-stage arthropathy who underwent total knee replacement. The implementation of a tailored protocol, not incorporating neuraxial techniques, such as spinal anesthesia, facilitated optimal intra- and postoperative pain management and expedited postoperative recovery and rehab without motor weakness and side effects, highlighting the potential benefit of such strategy in selected cases.