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Please confirm that an ethics committee approval has been applied for or granted: Yes: I’m uploading the Ethics Committee Approval as a PDF file with this abstract submissionBackground and Aims Effective postoperative pain management is essential for recovery and patient satisfaction. However, discrepancies between prescribed and administered analgesics—often due to unclear instructions or insufficient education—can negatively impact outcomes. This study aimed to assess the frequency and consequences of such discrepancies.Methods A retrospective analysis was conducted on postoperative analgesic therapy in patients undergoing total knee arthroplasty in 2024 at the Clinic for Traumatology, University Hospital Center Sestre milosrdnice, Zagreb. Data were obtained from the Hospital Information System.Results We analyzed data from 274 patients (156 women, 118 men; median age 70 years). Spinal anesthesia was used in 85% of cases. Perioperative analgesic blocks were given to 84.3% of patients—49.8% received a single-shot block and 50.2% a catheter. Catheters were mainly placed in the femoral region. Postoperative analgesia included parenteral ketoprofen, paracetamol, metamizole, oxycodone, and tramadol, as well as oral tramadol/paracetamol, short-acting morphine, and oxycodone/naloxone. In catheterized patients, local anesthetic boluses were possible up to three times daily. However, boluses were omitted in 41.4% of patients on day 0 and 25.9% on day 1. Only 15.4% received the full daily dose of paracetamol, and 59.4% received the full dose of ketoprofen, with some patients exceeding safe limits. Opioids were used perioperatively in 92.7% of cases.Conclusions Despite guideline recommendations for multimodal analgesia with limited opioid use, implementation was suboptimal. Improved adherence to protocols, clearer prescribing, and enhanced communication are needed to optimize postoperative pain management.