Opioid analgesics are the historical mainstay for postoperative cardiothoracic surgery pain relief. Although opioids are efficacious, they are linked with adverse effects, including sedation and respiratory depression. Emerging research is helping clinicians move toward evidence-based, opioid-sparing management strategies, including peripheral nerve blocks and multimodal analgesia. Good communication is essential to understanding patients’ perceptions of pain and attitudes toward different pain-relief methods. Preoperatively educating patients and families on expected nociception and treatment options decreases postprocedural pain. Discussing use of nonopioid analgesics for mild pain and instructions on tapering opioid medications at discharge may prevent future misuse.