This course explores how to safely move beyond opioid-centric anesthesia by leveraging multimodal, non-opioid analgesics, regional techniques, and enhanced recovery pathways. You’ll review the perioperative harms of opioids—from respiratory depression and ileus to delirium and long-term dependence—and see how agents like dexmedetomidine, ketamine, lidocaine, magnesium, acetaminophen, NSAIDs, gabapentinoids, and regional blocks can replace or dramatically reduce opioid use. By the end, you’ll be able to design practical opioid-sparing and opioid-free anesthetic plans that minimize surgical stress, improve functional recovery, and support true opioid stewardship in your practice.