Pain management remains a challenge in the optimization of outcomes after total knee arthroplasty. Multimodal analgesia is commonplace for modern elective joint replacement, combining various medications and anesthetics along the pain pathway. Local analgesics have the advantage of avoiding systemic effects and offering concentrated local delivery of medications. Long-acting local anesthetics provide the added advantage of providing sustained pain relief when other treatment options may no longer be effective. It is important to provide an update on current local analgesic strategies available with a review of the current literature, outlining the potential benefits and unique considerations of each treatment. Novel medications in development targeting pain management following total knee arthroplasty are possible options in the future.