Sixty-four patients undergoing arthroscopic shoulder surgery were randomized to receive intravenous paracetamol (n=32) or intravenous ibuprofen (n=32), each dosed first at wound closure and then every 6 hours; all patients had IV tramadol patient-controlled analgesia. The primary outcome was pain intensity (VAS). Secondary outcomes included total tramadol consumption (PCA and rescue), global satisfaction score, hemodynamics, and tramadol-related adverse effects. Outcomes were assessed at 1, 6, 12, and 24 hours postoperatively. Overall, the results revealed similar VAS at 1–12 h but lower VAS at 24 h with ibuprofen and significantly lower tramadol use. These findings suggest IV ibuprofen, within multimodal analgesia, yields modestly better late-first-day pain control and opioid-sparing compared with IV paracetamol.