Ninety-six patients with closed tibial shaft fractures were randomized to receive either an NSAID-based pain regimen (n=52) or an opioid-based pain regimen (n=44) following intramedullary nailing. The primary outcome of interest was opioid consumption, measured in morphine milligram equivalents (MMEs). Secondary outcomes included pain control assessed using the Visual Analog Scale (VAS) at 12-hour intervals and fracture union rates monitored over nine months. Opioid consumption was significantly lower at all time points in the NSAID group compared to the opioid group, while VAS scores were comparable except at the 24-hour mark, where pain was significantly lower in the NSAID group. No significant difference in fracture healing rates was observed between the groups (p=0.820). Overall, the results suggest that an NSAID-based protocol effectively reduces opioid use without compromising pain control or fracture healing, supporting its role as an alternative for postoperative pain management.