This chapter reviews key concepts regarding acute pain management in patients undergoing total knee arthroplasty (TKA). Patients presenting to TKA often have multiple relevant comorbidities that may complicate perioperative pain management. Furthermore, the pain resulting from this procedure is particularly challenging to address with otherwise common systemic analgesics, necessitating more advanced interventions that consider both pain intensity alongside patient function and rehabilitation. Many intraoperative anesthetic management decisions carry important implications for both early and longer-term postoperative function and pain management in this patient population. This chapter will provide a broad, case-based, evidence-supported review of modern approaches to enhanced recovery after surgery (ERAS) principles for patients presenting for total knee arthroplasty.