Aim: The study aimed to compare the efficacy and safety of opioid-free anesthesia versus opioid-based anesthesia in pediatric surgical patients, focusing on postoperative pain control, sedation levels, hemodynamic stability, and the incidence of postoperative nausea and vomiting (PONV). Materials and Methods: This prospective, randomized comparative study included 100 pediatric patients, aged 2 to 12 years, undergoing elective surgery. Patients were randomly assigned to two groups: 50 patients in Group 1 (Opioid-Free Anesthesia) and 50 patients in Group 2 (Opioid-Based Anesthesia). Group 1 received an opioid-free protocol consisting of propofol, dexmedetomidine, and lidocaine for induction and maintenance, along with paracetamol for analgesia. Group 2 received propofol and fentanyl for induction and maintenance, with additional fentanyl boluses for analgesia. Intraoperative hemodynamic parameters were monitored, and postoperative pain scores, sedation levels, PONV incidence, and recovery times were recorded. Results: The demographic characteristics of the two groups were similar, with no significant differences in age, gender distribution, or ASA physical status. Hemodynamic stability was maintained in both groups, with no significant differences in heart rate (HR), systolic blood pressure (SBP), or diastolic blood pressure (DBP) at any intraoperative time point (p > 0.05). Postoperative sedation scores were significantly higher in the opioid-based group at all time points (p < 0.001), with Group 2 showing prolonged sedation. Postoperative pain scores were slightly higher in Group 1 at early time points (p < 0.05), but the scores converged by 8 hours post-op. PONV incidence was higher in the opioid-based group (36% in Group 2 vs. 20% in Group 1, p = 0.032). Conclusion: Opioid-free anesthesia is a viable alternative to opioid-based anesthesia in pediatric surgical patients, offering comparable long-term pain control with significantly reduced sedation and a lower incidence of PONV. These findings suggest that opioid-free anesthesia may enhance recovery profiles by minimizing opioid-related side effects, particularly in pediatric patients.