Nephrectomy, whether performed laparoscopically or via an open approach, requires effective multimodal analgesia to manage postoperative pain while minimizing opioid use. This article reviews the anatomical basis of pain following nephrectomy and outlines various analgesic strategies. Postoperative pain has both somatic and visceral components, necessitating a combination of systemic analgesics and regional anaesthesia techniques. Key analgesic options include paracetamol, opioids, ketamine, alpha-2 agonists, and regional techniques such as transversus abdominis plane (TAP) blocks, quadratus lumborum blocks (QLB), and erector spinae plane (ESP) blocks. While thoracic epidurals remain a gold standard for open nephrectomy, they are less favored in laparoscopic cases due to complications such as hypotension and anticoagulation challenges. The use of intrathecal opioids, port-site infiltration, and liposomal bupivacaine offers alternative strategies for enhanced recovery. The role of regional anaesthesia in cancer surgery and considerations regarding NSAID use in patients with renal impairment are also discussed. A patient-specific approach, incorporating opioid-sparing techniques, early mobilization, and multimodal strategies, is crucial for optimizing recovery and minimizing complications.