Roy R, Agarwal G, Pradhan C, et al. - Given total pain free outcome after total knee arthroplasty has resulted in the evolution of regional blocks, and researchers revisited and modified Roy et al. 's technique of Ultrasound guided 4 in 1 block for knee and below knee surgeries, in this series, to afford a fully comprehensive and simple single injection technique for postoperative analgesia for Total Knee Arthroplasty (TKA). This study included 10 patients scheduled to undergo TKA. Medial femoral condyle was located using a linear USG-probe, then vastus and sartorius intersection was found. Till the descending genicular artery branching from superficial femoral artery was seen proximal to hiatus, the probe was slid. Experts, at this point, guided the needle with PNS attached into the Vastus medialis muscle till the stimulation of the nerve to Vastus medialis (0.4-0.5 mA). They injected 5–7 mL of 0.2% Ropivacaine at this point. The needle was guided in plane to perivascular region and following negative aspiration 0.2% ropivacaine 20–25 ml was injected, visualised to push the femoral artery. Findings in this series showed that good postoperative analgesia for TKA was achieved by adding USG and PNS guided Vastus medialis nerve block to USG 4-in-1 block in the technique.