Aim The programme of research within this thesis was developed to evaluate the current literature base for Enhanced Recovery Programmes (ERP) in orthopaedics and to specifically compare two methods of peri-operative analgesia, epidural or local infiltration analgesia, as the primary analgesic technique as part of an established ERP program and their impact on rehabilitation outcomes at discharge from hospital, six weeks and one year post-surgery . Methods Fundamental to enabling rehabilitation is good pain control whilst ensuring adequate muscle power to facilitate early ambulation and functional recovery. Local Infiltration Analgesia (LIA) has become synonymous with enhanced recovery programmes. A structured literature review and meta› analysis was developed to review the current literature and specifically whether local infiltration analgesia improved rehabilitation outcomes following total knee arthroplasty compared to other forms of regional analgesia. Six studies met the criteria for inclusion within the review which demonstrated low quality evidence in favour of infiltration, however of concern was the significant increase in adverse events recorded within the included trials. Therefore, following ethical approval a randomised controlled parallel group trial was carried out within an elective orthopaedic unit from April2010-August 2012. A total of242 patients undergoing primary TKA for osteoarthritis were recruited and received standardised pre-operative education, multimodal analgesia, accelerated rehabilitation and were randomised using a simple unrestricted randomisation method to receive either Patient Controlled Epidural Analgesia (PCEA) or LIA. Primary outcome measure was the proportion of patients discharged from rehabilitation by day four. Statistical significance was set at p