Eighty patients undergoing primary total hip arthroplasty were randomized to receive either opioid-free anesthesia with dexmedetomidine (OFA; n=40) or opioid-sparing anesthesia with a low dose of sufentanil (OSA; n=40). The primary outcome of interest was opioid consumption in the first 24 hours in oral morphine equivalences (OME). Secondary outcomes of interest included opioid consumption in the postanesthesia care unit (PACU), length of PACU stay, the incidence of adverse events, walking recovery time, and pain scores at rest and during movement on a Verbal Numeric Rating Scale (VNRS) in the first 24 hours. Outcomes were assessed for up to 24 hours. Overall, the results of the trial revealed no significant differences in the median cumulative OME consumption at 24 hours between the OFA and OSA groups. Both groups provided effective postoperative pain relief and facilitated early recovery. Overall, OFA does not reduce opioid consumption in the first 24 hours compared to OSA in patients undergoing total hip arthroplasty.