Seventy-four patients undergoing lower limb orthopedic surgeries under spinal anesthesia were randomized to receive either intranasal tapentadol (44.5 mg, n=37) or intravenous paracetamol (1 g, n=37) every 6 hours for 72 hours, starting 3 hours after surgery. The primary outcome was pain intensity measured by the Visual Analog Scale (VAS). Secondary outcomes included systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), and the need for rescue analgesia. Outcomes were assessed at multiple time points up to 72 hours post-intervention. Overall, the study revealed that intranasal tapentadol resulted in significantly lower pain scores compared to intravenous paracetamol. Additionally, patients in the tapentadol group required no rescue analgesia and exhibited favorable hemodynamic parameters.