Background: Improved recovery outcomes following knee surgeries are becoming increasingly prevalent in orthopedic procedures. Aim: To test whether femoral nerve block (FNB) with addition of dexmedetomidine can replace 4-in-1 block in enhanced recovery after knee and below knee operations. Patients and methods: This was comparative clinical trial single blinded research performed in Suez Canal University Hospitals from May 2022 to December 2023. Results: Statistically insignificant variances were reported in the context of the type of surgeries performed in each group as well as the duration of the surgeries performed comparing the FNB group to the 4 in 1 block group; p>0.05. Patients who underwent the 4-in-1 block exhibited statistically significantly lower VAS scores compared to those who received FNB; P value <0.05.On evaluating time to first rescue analgesia among both groups, it was observed that the 4-in-1 block group exhibited statistically significant prolonged intervals before requiring additional analgesia compared to the FNB group; p-value<0.0001. Values of TUG test at 24h postoperative were significantly lesser in the 4-in-1 block group than the femoral nerve block group p-value<0.05. Conclusion: Our research confirms the efficiency of the 4-in-1 block as a superior substitute to FNB in postoperative pain management and functional recovery following knee and below knee surgeries. It evaluates parameters like VAS score, consumption of morphine, period to 1^st rescue analgesia, SLR, TUG, and time to first mobilization, contributing to evidence-based decision-making in perioperative care.