Introduction: Postoperative pain management in India remains a significant challenge, with very high prevalence rates of postoperative pain in some regions. Data on postoperative pain prevalence and associated risk factors in India are limited. This study aims to address this gap by investigating the prevalence of postoperative pain and its potential risk factors with the goal of optimizing pain management practices. Materials and Methods: A prospective cohort study was conducted on adult patients (≥18 years) undergoing elective general or orthopedic surgery. Demographic data were collected during pre-operative visits, and pain levels were assessed using a numerical rating scale (NRS 0–10) at 4, 24, 36, and 48 hours postoperatively. A NRS score greater than 3 was classified as moderate to severe postoperative pain. Risk factors for postoperative pain were analyzed using univariate and multivariable binary logistic regression. Results: The study included 321 patients. The prevalence of postoperative pain was recorded as 60.12% at 4 hours, 71.96% at 24 hours, 67.91% at 36 hours, and 57.01% at 48 hours post-surgery. Pethidine was the most commonly prescribed analgesic in the first 24 hours postoperatively (85.05%), with only 1% of patients receiving paracetamol or diclofenac, and 12.15% receiving tramadol. Multivariable analysis identified general anesthesia and intraoperative analgesia as significant risk factors for postoperative pain. Conclusion: Postoperative pain management is currently inadequate, leading to a high prevalence of reported pain on the first postoperative day. This highlights the need for improved postoperative analgesia, particularly in low- and middle-income countries. Further research involving larger cohorts and examining additional risk factors could provide insights into enhancing pain management strategies.