The acute pain following a surgical procedure may be the most intense pain an individual experiences in their life. In addition, the perioperative experience may also be one of the greatest challenges and overall stressors for an individual. Perioperative pain management strives to mitigate the pain and help patients meet and supersede the challenges and stressors of surgery through a comprehensive strategy. The analgesic strategy may be designed within an enhanced recovery protocol that aims to decrease physiologic stress, restore homeostasis, and lead patients to faster recovery and better outcomes, or it may stand alone. Good perioperative pain management is critical to successful enhanced recovery protocols. In this chapter, we will discuss multimodal analgesic strategies and those for enhanced recovery protocols with an emphasis on orthopedic and spine surgeries.