Postoperative pain management is one of the most challenging jobs in orthopedic surgical population as it comprises of patients from extremes of ages and with multiple comorbidities. Though effective, opioids may contribute to serious adverse effects particularly in old age patients. Intravenous paracetamol is widely used in the postoperative period with the hope that it may reduce opioid consumption and produce better pain relief. A brief review of human clinical trials where intravenous paracetamol was compared with placebo or no treatment in postoperative period in orthopedic surgical population has been done here. We found that four clinical trials reported that there is a significant reduction in postoperative opioid consumption. When patients received an IV injection of 2？g propacetamol, reduction of morphine consumption up to 46% has been reported. However, one study did not find any reduction of opioid requirement after spinal surgery in children and adolescent. Four clinical trials reported better pain scores when paracetamol has been used, but other three trials denied. We conclude that postoperative intravenous paracetamol is a safe and effective adjunct to opioid after orthopedic surgery, but at present there is no data to decide whether paracetamol reduces opioid related adverse effects or not. 1. Introduction Postoperative pain is a major challenge in patients undergoing orthopedic surgery. Effective treatment of postoperative pain by multimodal approach is important as pain can cause neuroendocrine stress responses and other harmful effects such as autonomic reflexes with adverse effects on organ function and reflex muscle spasm [1], and in children it can cause long-lasting behavioral changes [2]. Commonly used drugs to reduce postoperative pain following orthopedic surgery include opioid, nonsteroidal anti-inflammatory drugs (NSAIDs), and paracetamol. Even though opioids are considered as the primary analgesic therapy in moderate to severe postoperative pain, these drugs do not provide optimum patient satisfaction as they are associated with dose-related adverse effects such as sedation, respiratory depression, postoperative nausea and vomiting, pruritus, and urinary retention [3, 4]. NSAIDs are associated with many adverse effects such as gastrointestinal injury, increased operative site bleeding, renal toxicity, and bronchoconstriction [5, 6]. In addition, NSAIDs have been shown to interfere with fracture healing, bone-tendon healing, spinal fusion, and bone tendon formation [7, 8]. Paracetamol with its high safety profile in
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