Aim: To compare the efficacy and safety of high-dose intravenous (IV) paracetamol versus tramadol in managing postoperative pain in orthopedic and ENT surgeries. Materials and Methods: This randomized comparative study included 120 postoperative patients aged ≥18 years, assigned into two groups of 60 each. Group 1 received IV paracetamol (1000 mg) as an infusion over 15 minutes, while Group 2 received IV tramadol (50 mg or 2 mg/kg) as a slow infusion. Both drugs were administered at 0, 8, and 16 hours postoperatively. Pain intensity was measured using the Visual Analogue Scale (VAS) at specific intervals, along with monitoring of vital parameters (pulse rate, blood pressure, respiratory rate) and adverse effects such as nausea, vomiting, and drowsiness. Statistical analysis was conducted using SPSS version 25.0, with p < 0.05 considered significant. Results: Group 1 (IV paracetamol) demonstrated superior pain control, with significantly lower VAS scores across all time points (p < 0.001) and better hemodynamic stability. Pulse rates and respiratory rates were significantly lower in Group 1 (p < 0.01), and both systolic and diastolic blood pressures were better controlled (p < 0.05). Adverse effects were more frequent in Group 2 (IV tramadol), with nausea/vomiting reported in 25.00% compared to 8.33% in Group 1 (p = 0.007). Drowsiness was also higher in Group 2 (16.67% vs. 6.67%), though not statistically significant. Conclusion: High-dose IV paracetamol is a safer and more effective alternative to tramadol for postoperative pain management in orthopedic and ENT surgeries. Its superior pain relief, better hemodynamic stability, and fewer adverse effects make it an excellent choice in multimodal analgesia protocols.