ABSTRACT Background and Aim: One of the most common problems of cataract surgery is postoperative pain. This study aimed to compare the effect of intravenous acetaminophen in comparison with fentanyl on pain severity reduction after cataract surgery. Materials and Methods:In a double-blind clinical trial, a total of 110 patients who were scheduled for cataract surgery participated in the study. Hemodynamic changes, postoperative pain Side effects and the need for methadone were assessed. Results: The results showed that there was no significant difference between the two groups in systolic pressure, diastolic pressure, heart rate, and oxygen saturation. There was no notable difference in pain relief between the two groups at 1, 6, 12, and 24 hours post-surgery. Furthermore, there was no notable difference in side effects observed after induction and six hours later. However, a significant difference was noted between the two groups during the first hour, with Fentanyl resulting in a higher incidence of side effects compared to acetaminophen. Analysis of the need for methadone administration later revealed no significant difference between the two groups. Conclusion: Given the possible adverse effects of fentanyl, the administration of acetaminophen could be used as an effective and safe alternative for managing pain following cataract surgery.