TO THE EDITOR: The progress of contemporary perioperative medicine is accompanied by increasing questioning in current clinical practice. One of these questions is regarding the use of routine perioperative opioids. For many years, opioid-based anesthesia has been the cornerstone of analgesia management in both intraoperative and postoperative periods. High-dose opioid induction and maintenance, a technique that dates as far back as the 1980s, has been deemed the gold standard for cardiac surgery patients. However, over time, it became clear that high-dose opioid regimens were associated with side effects such as prolonged mechanical ventilation, increased length of stay in the intensive care unit (ICU) or hospital, impaired gastrointestinal function, postoperative nausea and vomiting, pruritus, urinary retention, delirium, and the potential development of opioid addiction [1]. Before the 2000s, a recommendation to 'fast track' after cardiac surgery was proposed [2]. Accordingly, there have been changes in the technique, and balanced anesthesia has become more preferred. Smaller doses of short-acting opioids, non-opioid analgesics, adjuvant drugs, regional blocks, and inhalational anesthetic agents were used in patients. With the fast track method, it was shown that the durations of mechanical ventilation, intensive care, and hospital stay were shortened, and cost was reduced. Therefore, the technique has become an obvious advantage [3]. Acute tolerance and hyperalgesia caused by opioids serve as an incentive for opioid use in the perioperative period. This is followed by an increased risk of addiction. All of these disadvantages became apparent over time, and doctors turned to less-opioid or opioid-free anesthesia techniques to overcome these problems. Opioid-free anesthesia (OFA) is a technique in which non-opioid multimodal analgesics are used to provide adequate pain control during the perioperative period [4]. There are many alternative non-opioid analgesic drugs with lower dependency potentials and better side effect profiles for the application of OFA. In the OFA protocol used in our clinic, many non-opioid analgesic drug combinations were applied over the long time interval between the preoperative period and discharge. The night before the operation, the patient is administered a pregabalin 150 mg oral tablet. In addition, 0.25 µg/kg i.v. dexmedetomidine is administered for 10 min during the preoperative period. A 50 ml solution containing 50 µg dexmedetomidine, 50 mg ketamine, and 500 mg lidocaine is prepared. Immediately before anesthesia induction, 1 ml/10 kg/10 min infusion of the solutions administered. Anesthesia is then induced with propofol and rocuronium. Fifty milligrams of ketamine is added before surgery. For anesthesia maintenance, the solution is continued throughout the operation by reducing the dose to 1 ml/10 kg/h, and a volatile agent is administered according to the bispectral index (BIS) value. Additionally, 1.5 mg of magnesium is administered before cardiopulmonary bypass (CPB) and 1 g of paracetamol is administered during sternum closing. Infiltration anesthesia is administered with 10 ml of 0.25% bupivacaine in the chest drain regions. At the end of the operation, the solution dose is reduced to 0.5 ml/10 kg/h and continued until extubation in the postoperative period. Paracetamol (1 g) is administered every 6-8 h for the first 24 h. If the visual analog score is over 4 points, tramadol hydrochloride 1 mg/kg is administered as a rescuer therapy. The patients are extubated within 2-3 h. Non-steroidal anti-inflammatory analgesic drugs are not suitable for cardiac surgery because of their prothrombotic effects [5]. Therefore, they are not included in the OFA protocol. The erector spina-plane block is also added preoperatively to this defined protocol according to the patient's request. We would like to present three cases in which our OFA protocol was used. The necessary patient and publication consent has been obtained.