As a result of the opioid epidemic there is an increased interest among CRNAs to decrease or eliminate the use of opioids intraoperatively. The barrier to implementing an opioid free anesthesia technique is most commonly due to the unfamiliarity of medications used. This lecture will review why and how to prevent peripheral and central sensitization. There will be a thorough discussion about mechanism of action and dosing of intravenous and oral medications used in opioid free anesthesia. Case examples of how patients benefit from opioid free anesthesia will be presented.