Total hip replacement surgery is painful. The anaesthetist and person undergoing surgery can choose from a number of interventions which aim to minimise this. Firstly there is a choice of underlying anaesthesia and the options are general anaesthesia, regional anaesthesia, or a combination of both. General anaesthesia is where the patient is put into a deep sleep. Regional anaesthesia is where only part of the body is anaesthetised, using local anaesthetic to ‘turn off’ the nerves temporarily. During this time, the patient is typically aware of some pushing or pulling, but no pain. Once it has been decided whether to use general, regional anaesthesia or both, then the technique or combination of techniques, needed to prevent pain after the operation should be considered. Preventing early pain is important in itself and, it is also recognised that reducing pain in the first few hours after surgery may help reduce pain over a longer period. There are 2 supplementary anaesthetic options that can be utilised. Firstly, local anaesthetic infiltration where a large volume of anaesthetic is injected into the tissues around the operation site. This technique typically lasts for 8 to 10 hours. A second approach is to target an injection of anaesthetic to the nerves that supply the hip joint, often using an ultrasound machine to identify the nerve. Local anaesthetic infiltration and nerve blocks can be performed separately, or together. This review seeks to determine the most clinically effective and cost-effective approach to both types of anaesthetic, and the type of supplementary anaesthetic options for total hip replacement.