Total knee arthroplasty – The optimal analgesic regime

•Update recommendations for analgesia for total knee arthroplasty.•Clear guidelines for the everyday practitioner.•In depth analysis of the current evidence for established and emerging techniques.

Despite over one million knee replacements being undertaken worldwide per year, there is still no widely accepted optimal analgesic regime for this procedure. This article examines and appraises the options for total knee arthroplasty in the current environment which mandates rapid discharge from hospital. Peripheral nerve blockade and multimodal analgesic options are covered in detail, along with newer techniques such as high volume local anaesthetic infiltration and infiltration with liposomal bupivacaine. Recommendations are made for the straightforward patient and the patient with chronic pain or opioid requirements.