Ultrasound guided 4 in 1 block for managing postoperative pain in arthroscopic knee surgery

Surgeries of the knee are usually painful and managing postoperative pain is challenging. Various methods of analgesia are available. Epidural is considered as gold standard but after the advent of ultrasound, peripheral nerve blockade of the lower limb is gaining importance. A 50-year-old male patient posted for arthroscopic knee surgery, completed under spinal anaesthesia, was given four in one block using ultrasound. The point of entry of the needle was in lower thigh where the femoral artery dips down deep. 30ml of 0.25% bupivacaine was given in the space above it. Postoperatively, the time of first systemic analgesia was noted which was eight hours after full regression from spinal. Peripheral nerve blocks of the lower limb for knee surgeries usually target only the femoral component. Addressing the sciatic component with a single injection is a real challenge and we did it to block the four nerves with a single point injection. We conclude 4 in 1 block is useful as a postoperative analgesic technique in knee surgeries.