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Background and Aims In a single paediatric centre, a wide variability of perioperative analgesia regimes existed in elective knee surgery patients, leading to unpredictable post-operative pain outcomes. In adults, knee surgeries have a high incidence of severe post-operative pain, and various motor sparing regional anaesthesia techniques have been assessed. In paediatrics, multiple international guidelines exist for best practice postoperative pain management. Therefore, a review of departmental practice was undertaken.Methods A retrospective chart review of any patient who underwent an elective knee procedure over an eighteen month period was performed. A total of 41 cases were identified to analyse. Data was collected and inputted into an excel audit tool on a hospital password encrypted computer.Results Demographics revealed 54% male (n=22), 46% female (n=19). Patient age range 11–18 years old. Postoperative simple analgesia prescribing; 93% for paracetamol, 90% for non-steroidal anti-inflammatory drugs (NSAID). Numerical pain scores were documented in 88% (n=36). Rescue opiate analgesia was prescribed in 98% (n=40) and used in 59% (n=24). Rescue antiemetic was prescribed in 93% (n=38) and used in 22% (n=9). 100% of patients received local anaesthetic intra-operatively; peripheral nerve block (PNB) in 68%, local infiltration of anaesthetic (LIA) in 5%, PNB and LIA in 27%. PNB choice was 37% adductor canal (AC) (n=15), 27% AC and iPACKS (n=11), 15% AC, iPACKs and Genicular (n=6), 7% AC and Genicular (n=3). The AC and iPACKS combination had the lowest post-operative pain scores, rescue opiate usage and average opiate usage. 42% (n=17) were daycases, with 5% (n=2) resulting in delayed discharge.Conclusions This study shows excellent departmental compliance with international post-operative pain management recommendations. Given the variability in PNB performed, there is a role for a future randomised control trial to further analyse postoperative outcomes comparing PNB to LIA, with the potential to introduce a formal analgesia pathway for this cohort of patients.