Korean J Anesthesiol anesthesia cannot be performed. In order to increase efficacy and safety of FSNB for TKRA, further investigations using ultrasound imaging are warranted. In conclusion, FSNB offers a beneficial alternative anesthesia and postoperative analgesia to the patients undergoing TKRA. References 1. Rawal N, Van Zundert A, Holmstrom B, Crowhurst JA. Combined spinal-epidural technique. Reg Anesth 1997; 22: 406-23. 2. Green L, Machin SJ. Managing anticoagulated patients during neuraxial anaesthesia. Br J Haematol 2010; 149: 195-208. 3. Howell SJ, Sear YM, Yeates D, Goldacre M, Sear JW, Foex P. Risk factors for cardiovascular death after elective surgery under general anaesthesia. Br J Anaesth 1998; 80: 14-9. 4. Moen V, Dahlgren N, Irestedt L. Severe neurological complications after central neuraxial blockades in sweden 1990-1999. Anesthesiology 2004; 101: 950-9. 5. Fanelli G, Casati A, Garancini P, Torri G. Nerve stimulator and multiple injection technique for upper and lower limb blockade: failure rate, patient acceptance, and neurologic complications. Study Group on Regional Anesthesia. Anesth Analg 1999; 88: 847-52. 6. Allen HW, Liu SS, Ware PD, Nairn CS, Owens BD. Peripheral nerve blocks improve analgesia after total knee replacement surgery. Anesth Analg 1998; 87: 93-7. 7. Hogan MV, Grant RE, Lee L Jr. Analgesia for total hip and knee arthroplasty: A review of lumbar plexus, femoral, and sciatic nerve blocks. Am J Orthop (Belle Mead NJ) 2009; 38: E129-33. 8. Ganidagli S, Cengiz M, Baysal Z, Baktiroglu L, Sarban S. The comparison of two lower extremity block techniques combined with sciatic block: 3-in-1 femoral block vs. psoas compartment block. Int J Clin Pract 2005; 59: 771-6. 9. Bouaziz H, Vial F, Jochum D, Macalou D, Heck M, Meuret P, et al. An evaluation of the cutaneous distribution after obturator nerve block. Anesth Analg 2002; 94: 445-9. 10. Marhofer P, Nasel C, Sitzwohl C, Kapral S. Magnetic resonance imaging of the distribution of local anesthetic during the three-in- one block. Anesth Analg 2000; 90: 119-24. 11. McNamee DA, Parks L, Milligan KR. Post-operative analgesia following total knee replacement: an evaluation of the addition of an obturator nerve block to combined femoral and sciatic nerve block. Acta Anaesthesiol Scand 2002; 46: 95-9. 12. Macalou D, Trueck S, Meuret P, Heck M, Vial F, Ouologuem S, et al. Postoperative analgesia after total knee replacement: the effect of an obturator nerve block added to the femoral 3-in-1 nerve block. Kim, et al. Anesth Analg 2004; 99: 251-4. 13. Eifert B, Hahn R, Maier B, Konrad F, Georgieff M. Combined "3-in- 1"/sciatic nerve block. Block effectiveness, serum level and side effects using 700 mg mepivacaine 1% without and with adrenaline and prilocaine 1%. Anaesthesist 1996; 45: 52-8. 14. Hirst GC, Lang SA, Dust WN, Cassidy JD, Yip RW. Femoral nerve block. Single injection versus continuous infusion for total knee arthroplasty. Reg Anesth 1996; 21: 292-7. 15. Etches RC, Warriner CB, Badner N, Buckley DN, Beattie WS, Chan VW, et al. Continuous intravenous administration of ketorolac reduces pain and morphine consumption after total hip or knee arthroplasty. Anesth Analg 1995; 81: 1175-80. 16. Serpell MG, Millar FA, Thomson MF. Comparison of lumbar plexus block versus conventional opioid analgesia after total knee replacement. Anaesthesia 1991; 46: 275-7. 17. Chelly JE, Greger J, Gebhard R, Coupe K, Clyburn TA, Buckle R, et al. Continuous femoral blocks improve recovery and outcome of patients undergoing total knee arthroplasty. J Arthroplasty 2001; 16: 436-45. 18. Capdevila X, Barthelet Y, Biboulet P, Ryckwaert Y, Rubenovitch J, d'Athis F. Effects of perioperative analgesic technique on the surgical outcome and duration of rehabilitation after major knee surgery. Anesthesiology 1999; 91: 8-15. 19. Rawal N, Schollin J, Wesstrom G. Epidural versus combined spinal epidural block for cesarean section. Acta Anaesthesiol Scand 1988; 32: 61-6. 20. Davies AF, Segar EP, Murdoch J, Wright DE, Wilson IH. Epidural infusion or combined femoral and sciatic nerve blocks as perioperative analgesia for knee arthroplasty. Br J Anaesth 2004; 93: 368-74. 21. Zaric D, Boysen K, Christiansen C, Christiansen J, Stephensen S, Christensen B. A comparison of epidural analgesia with combined continuous femoral-sciatic nerve blocks after total knee replace- ment. Anesth Analg 2006; 102: 1240-6. 22. Singelyn FJ, Deyaert M, Joris D, Pendeville E, Gouverneur JM. Effects of intravenous patient-controlled analgesia with morphine, continuous epidural analgesia, and continuous three-in-one block on postoperative pain and knee rehabilitation after unilateral total knee arthroplasty. Anesth Analg 1998; 87: 88-92. 23. Yang WT, Chui PT, Metreweli C. Anatomy of the normal brachial plexus revealed by sonography and the role of sonographic guidance in anesthesia of the brachial plexus. AJR Am J Roentgenol 1998; 171: 1631-6. 24. Orebaugh SL, Williams BA, Kentor ML. Ultrasound guidance with nerve stimulation reduces the time necessary for resident peripheral nerve blockade. Reg Anesth Pain Med 2007; 32: 448-54. www.ekja.org 453