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Background and Aims Peripheral nerve blocks (PNBs) are often associated with rebound pain, a significant clinical issue. Management strategies for mitigation have been discussed in the literature, and favourable outcomes may be obtained with either continuous PNB’s and timed systemic analgesics. Our study aimed to formally evaluate the effect of these analgesic pathways on rebound pain following ankle fracture surgery.Methods This was a three armed randomised control trial involving 120 patients undergoing surgery for ankle fracture ORIF. All patients received an ultrasound guided popliteal-sciatic and saphenous nerve blocks (10 ml of Bupivacaine 0.5% with 5 ml of 2% lignocaine in each site) as well as a standardised general anaesthetic. Patients were randomised to a postoperative multimodal oral analgesia protocol (Group C), a timed opioid analgesic protocol (Group TO) or a sciatic catheter protocol (Group SC). Our primary outcome was median peak pain score 24 hours after block administration. Our secondary outcomes included the impact of intervention on quality of recovery, and subpopulation at highest risk of rebound pain.Results 120 eligible patients were randomized 1:1:1 to three groups (C=42, TO=39, SC=39). After subject attrition, 37, 33, and 35 patients were analysed in each group, respectively. There was no statistically significant difference between groups in peak postoperative pain scores at 24 hrs (K-W, p=0.15), at 24–48 hrs (K-W, p=0.89), in QOr9 scores at 24 hrs (K-W, p=0.46 ), or in QoR9 scores at 24–48 hrs (K-W, p=0.55).. A significantly higher percentage of individuals in the catheter group (34%) reported no pain at 24 hours compared to the conventional therapy group (14%) and the timed opioid group (6%).Conclusions When compared to conventional postoperative multimodal analgesia, administration of a timed opioid or use of a continuous perineural sciatic catheter is not associated with a statistically significant reduction in peak pain scores at 24 and 48 hours post ankle fracture surgery