<p>Total Knee Arthroplasty (TKA) is a widely used procedure to relieve disability associated with advanced knee osteoarthritis. The management of postoperative TKA is crucial for the success of surgery and patient satisfaction. This study aims to determine the effects of integrating transcutaneous electrical nerve stimulation into standard postoperative TKA care on acute resting pain scores and intravenous analgesic requirements during the first three postoperative days. This randomised controlled trial was conducted from July to December 2022 at two hospitals in Lahore, Punjab, Pakistan. A total of 60 participants with TKA, aged 41 to 85 years, were recruited through purposive sampling. The control group received standard intravenous analgesics and postoperative rehabilitation, and the experimental group received transcutaneous electrical nerve stimulation (TENS) additionally. TENS was applied at a frequency of 85&#xa0;Hz, pulse width of 120 µs, and at low intensity as tolerated. Pain was measured through the numeric pain rating scale, and analgesic requirements were monitored through the prescription chart. The results showed significant between-group differences in pain reduction (<i>p</i> &lt; 0.001), whereas no statistically significant difference was observed in drug dose (<i>p</i> = 0.06) and frequency (<i>p</i> = 0.032/ corrected <i>p</i> = 0.0167). TENS was a useful integrated modality to conservative pharmacological management of pain after total knee arthroplasty.</p><p>Trial registration: This trial was prospectively registered at ClinicalTrials.gov (Trial ID NCT05470244) on 13th July, 2022. https//clinicaltrials.gov/study/NCT05470244.</p>