The concept of integrating pain management into the surgical process as a single entity is new and exciting. The use of local anaesthetic to block post-operative pain at the site of its generation is here refined into a management program allowing early mobilisation and dramatic pain control in the early post-operative period. This multimodal technique is demonstrated here with application to lower limb arthroplasty and spinal surgery. This is not only a detailed explanation and instruction in the technique and concept but a historical perspective on its development and will be of great interest to all orthopaedic surgeons as well as anaesthetists. Using easy-to-understand terminology this text covers: LIA methods Pre- and postoperative management How to select a needle injection location The benefits of combining the LIA technique with the drugs Naropin Marcain and Xylocaine Color images throughout the text highlight the advantages of LIA including: avoidance of sedation simple execution for physicians reduced risk of infection and blood clots little physiological disturbance earlier patient discharge and return to the workforce improved patient performance outlook and mobility fewer medical expenses