Total ankle arthroplasty is a procedure that has been shown to greatly improve patient quality of life. However, it is associated with moderate to severe postoperative pain. Commonly used strategies for pain control include opioids, multimodal analgesia with nonsteroidal anti-inflammatory drugs, acetaminophen and gabapentinoids, and regional anesthetic techniques such as peripheral nerve blocks. Nerve blocks in particular afford high-quality relief from pain while avoiding many of the side effects of traditional systemic therapies. This review highlights the state-of-the-art practice for providing postoperative analgesia following total ankle arthroplasty.