This is a single-center, retrospective case-cohort analysis that assessed the impact of rigid-plate fixation and an enhanced recovery protocol on postoperative outcomes following median sternotomy. The analysis included 608 patients, with a mean age of 66 years, of whom 59 percent underwent isolated coronary artery bypass grafting. The findings revealed a significant reduction in postoperative opioid use: the control group received a median of 172.5 morphine milligram equivalents, while patients receiving rigid-plate fixation and the enhanced recovery protocol patients reported 0 morphine milligram equivalents (P < .0001). Patient-reported pain scores remained similar or slightly improved across the groups. Opioid prescriptions at discharge reflected these changes, with the control group receiving a median of 600 morphine milligram equivalents compared to 0 for the rigid-plate fixation and enhanced recovery protocol groups (P < .0001).The implementation of rigid-plate fixation and an enhanced recovery protocol led to a significant reduction in opioid use and improved discharge outcomes for patients, highlighting the effectiveness of these strategies in managing postoperative recovery.