Seventy-four patients undergoing elective upper limb orthopedic surgery were randomized to receive either oral pregabalin 150 mg (n=37) one hour before surgery or oral gabapentin 300 mg (n=37) two hours before surgery. The primary outcome was postoperative pain intensity assessed by visual analog scale (VAS). Secondary outcomes included pain scores at different time points (preoperative, PACU, 6 hours, and 12 hours), morphine use, side effects, and liver/renal function. Pain scores were assessed up to 12 hours postoperatively. Overall, the results revealed that pain scores decreased over time in both groups; however, the reduction was significantly greater in the pregabalin group. This study suggests that oral pregabalin is more effective than gabapentin in reducing postoperative pain in upper limb orthopedic surgery.