Three hundred fifteen patients undergoing five common elective orthopedic procedures were randomized to receive either an opioid-free perioperative pain management protocol (n=157) or an opioid-containing protocol (n=158). The primary outcome was the numeric rating scale (NRS) for pain at 24 hours postoperatively. Secondary outcomes included pain levels at other time points (6 and 12 hours; 2 weeks, 6 weeks, and 1 year), comfort, opioid consumption, patient-reported outcomes, and adverse events. Outcomes were assessed up to 1 year post-surgery. Overall, the results revealed that the opioid-free protocol was noninferior to the opioid-containing protocol for pain at 24 hours. Pain levels were significantly lower in the opioid-free group at 12 hours and 2 weeks. The opioid-free group also reported better comfort at 24 hours and greater satisfaction with pain control at 6 weeks. No significant differences in adverse events or readmissions were observed. These findings suggest that an opioid-free protocol can safely and effectively manage pain in the perioperative setting for orthopedic procedures.