Objective: To investigate the role of popliteal arterion-knee retrocapsular space block (IPACK) -adductor block (ACB) in optimizing analgesia and reducing the risk of foot drop after total knee replacement. Methods The clinical data of 100 patients undergoing total knee arthroplasty in our hospital from October 2023 to October 2024 were retrospectively collected. Patients were divided into control group (ACB, n=49) and observation group (IPACK-ACB, n=51) according to the difference in analgesia regimen. Perioperative indexes, pain status [pain scale scale (VAS)], quadriceps muscle strength, foot drop risk and adverse reactions were collected and compared between the two groups. Results The first postoperative analgesia time of the observation group was significantly longer than that of the control group, the number of analgesia pump was significantly less than that of the control group, and the time of getting out of bed was significantly shorter than that of the control group (P<0.05). The VAS scores of the observation group were significantly lower than those of the control group at 6h and 12h after rest and activity (P<0.05). There was no significant difference in VAS scores between the two groups at 24h after rest and activity (P>0.05). At 6h, 12h, 24h and 48h after operation, there were no significant differences in quadriceps muscle strength between the two groups (P>0.05). The incidence of foot drop in the observation group was significantly lower than that in the control group (P<0.05). There was no significant difference in the occurrence of adverse reactions between the two groups (P > 0.05). Conclusion The combined application of ACB and IPACK anesthesia in total knee arthroplasty can reduce postoperative pain and the incidence of foot drop, promote functional recovery of patients with high safety Reduce.