Forty-four adolescents with idiopathic scoliosis (AIS) were randomized to receive a surgeon-directed subfascial cocktail of ropivacaine 0.75% (20 mL), methylprednisolone 40 mg, and ketoprofen 50 mg (n=23) or saline (40 mL) (n=21) at wound closure during posterior fusion. The primary outcome was postoperative pain on an NRS (0–10) at 1 h, 6 h, and daily to postoperative day (POD) 3; secondary outcomes included time to independent ambulation, epidural use, fentanyl MME (intraop and IV-PCA), acetaminophen use, labs, and adverse events up to 1 year. Overall, the results of the study revealed lower pain at 1 h (4.1 ± 3.7 vs 5.6 ± 2.9; P=0.044) and earlier ambulation (2.5 ± 0.5 vs 3.3 ± 1.6 days; P=0.032) in the cocktail group, but no between-group differences after 6 h in NRS or in rescue/adjunct analgesic consumption. These findings suggest the cocktail offers only transient analgesia and modestly hastens mobilization, reinforcing the need for broader multimodal regimens.