This study investigated the impact of peripheral nerve blocks, specifically adductor canal block (ACB) and IPACK block, on chronic post-surgical pain (CPSP) and functional outcomes in patients undergoing total knee arthroplasty (TKA). A prospective observational study of 166 patients, followed up for 2 years, found that patients who received ACB and IPACK blocks had significantly lower opioid consumption, reduced postoperative pain, and better functional outcomes compared to those who did not receive blocks. Opioid consumption was 9.74 ± 3.87 mg in the block group versus 30.63 ± 11.52 mg in the non-block group (p < 0.001). CPSP was present in 20.24% of patients without blocks and 6.1% with blocks (p = 0.011). Predictor variables for CPSP included preoperative pain (cut-off of 5.5), pain at rest (cut-off of 2.35), pain during active movement (cut-off of 2.5), and opioid consumption (cut-off of 8 mg). The block group had higher scores on the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the Forgotten Joint Score (FJS), indicating better functional recovery and reduced awareness of the artificial knee joint. The study concluded that peripheral nerve blocks provide adequate analgesia, reduce opioid use, improve functional outcomes, and decrease the incidence of CPSP 2 years after surgery. The findings suggest that the combination of ACB and IPACK blocks is beneficial for post-TKA pain management and functional recovery.This study investigated the impact of peripheral nerve blocks, specifically adductor canal block (ACB) and IPACK block, on chronic post-surgical pain (CPSP) and functional outcomes in patients undergoing total knee arthroplasty (TKA). A prospective observational study of 166 patients, followed up for 2 years, found that patients who received ACB and IPACK blocks had significantly lower opioid consumption, reduced postoperative pain, and better functional outcomes compared to those who did not receive blocks. Opioid consumption was 9.74 ± 3.87 mg in the block group versus 30.63 ± 11.52 mg in the non-block group (p < 0.001). CPSP was present in 20.24% of patients without blocks and 6.1% with blocks (p = 0.011). Predictor variables for CPSP included preoperative pain (cut-off of 5.5), pain at rest (cut-off of 2.35), pain during active movement (cut-off of 2.5), and opioid consumption (cut-off of 8 mg). The block group had higher scores on the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the Forgotten Joint Score (FJS), indicating better functional recovery and reduced awareness of the artificial knee joint. The study concluded that peripheral nerve blocks provide adequate analgesia, reduce opioid use, improve functional outcomes, and decrease the incidence of CPSP 2 years after surgery. The findings suggest that the combination of ACB and IPACK blocks is beneficial for post-TKA pain management and functional recovery.