Abstract Background: Tonsillectomy, a routine paediatric procedure, is frequently accompanied by significant postoperative pain. Efficient pain control is essential to minimize morbidity. Peritonsillar infiltration of tramadol or bupivacaine may offer an effective localized analgesic alternative. Objective: To compare the analgesic efficacy and safety of tramadol and bupivacaine peritonsillar infiltration in children post-tonsillectomy. Methods: A randomized, double-blind, placebo-controlled study involving 90 children (aged 5–12 years) undergoing tonsillectomy was conducted. They were divided into: Group T: Tramadol 2 mg/kg (2 mL/tonsil) Group B: Bupivacaine 0.25% (2 mL/tonsil) Group C: Placebo (2 mL normal saline) Pain was assessed using the Wong-Baker FACES Pain Rating Scale at 1, 4, 8, 12, and 24 hours postoperatively. Secondary outcomes included time to first rescue analgesic and total analgesic consumption.