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Objective: To evaluate the impact of a focused enhanced recovery protocol (ERP), which included targeted pharmacologic interventions and multimodal analgesia management, on postoperative parenteral opioids use (PPO) and length of hospital stay (LOS). Design: Before-after and non-randomized control trial. Setting: General community hospital. Patients: 109 consecutive patients undergoing elective segmental colectomy. Interventions: Group 1 (n=39): patients from surgical team 1 implementing ERP; group 2 (n=34): time-matched controls from team 2 not using ERP; group 3 (n=36): historical controls from team 1 before introduction of ERP. Cases for the three groups were compiled by gender, age, ASA class, diagnosis, right or left colectomy, laparoscopic/robotic (lap) or open technique. Main Outcome Measures: Utilization of PPO overnight and overall, incidence of postoperative ileus, LOS, 30-day readmission rate. Results: Overnight average PPO use in mg of hydromorphone analgesic equivalents was: 1.78 in group 1, vs 5.15 in group 2 (p<0.0001), vs 4.36 in group 3 (p=0.0006). Total average PPO use was 2.69 in group 1, vs 16.17 in group 2 (p<0.0001), vs 10.30 in group 3 (p=0.0017). Nine patients in group 1 received no PPO. Average LOS in days for group 1 was 2.31 (lap= 2.11, open= 2.82), vs 6.32 for group 2 (lap= 4.38, open= 7.52) (p<0.0001), vs 4.08 for group 3 (lap= 3.38, open= 5.06) (p<0.0001). Five patients in group 1 had 1-day LOS. There were 2 ileus cases in group 1 (5.3%), 7 in group 2 (20.6%), and 5 in group 3 (13.9%). There were no 30-day readmissions in group 1. Conclusions: A targeted ERP for elective colectomy proved feasible and effective in reducing PPO, ileus and LOS, with very favorable cost and safety profile.