Regional anaesthesia is essential for hip arthroplasty programmes and depends on anaesthesiologist’s experienced choice. Good analgesia and the avoidance of post-operative nausea and vomiting are prerequisites for early ambulation and patient compliance with post-operative protocols. Regional anaesthesia, both neuraxial and peripheral nerve blocks, is superior to systemic opioid analgesia at all-time points in the first 3 days following surgery and by avoiding opioids, the risks and incidence of opioid analgesia are removed. Safety of drugs for intrathecal injections and complications from spinal anaesthesia continue to be examined and re-examined in order to improve safety of the technique. Prevention of post-operative cognitive dysfunction and early mobilisation is a key part of the management of patients with hip fractures.