97 patients undergoing total hip arthroplasty were randomized to receive an opioid-free pain management protocol (n=47) or a standard, opioid-based pain management protocol (n=50). The primary outcome of interest was Numeric Rating Scale (NRS) pain scores at 24 hours or discharge. Secondary outcomes of interest included satisfaction with pain control, complications, and the Hip disability and Osteoarthritis Outcome Jr Score (HOOS Jr). Median follow up was 2 months (IQR 1, 11). Pain scores were not significantly different between the two groups at 24 hours. Satisfaction with pain control, HOOS Jr scores, anti-emetic use, and the rate of falls were similar between groups. Constipation occurred more frequently in the opioid-based group. 15% of patients in the opioid-free group required narcotic pain medication.