OBJECTIVES: To assess the efficacy of a new, ready-to-use intravenous paracetamol in postoperative pain management in comparison with placebo, oral paracetamol, propacetamol and other NSAIDs. METHODS: Electronic databases search (Medline - PubMED, EMBASE, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Core Biomedical Collection), until March 2006, was conducted for randomised controlled trials on postoperative pain management with intravenous paracetamol in monotherapy or in combined treatment. Only full text articles published in peer-reviewed journals were accepted. Study results were combined in meta-analysis plots using RevMan, where appropriate. RESULTS: Six studies met the inclusion criteria: four compared intravenous paracetamol with placebo, one with oral paracetamol, two with propacetamol and one with metamizole. All studies were methodologically of high quality (average 4.83 points in Jadad scale). Treatment with intravenous paracetamol was significantly superior to placebo in pain relief, pain intensity difference, reduction of opioid consumption and patient treatment satisfaction (by 22% to 325%). Patients treated with intravenous paracetamol received less opioids than treated with oral paracetamol, whereas incidence of postoperative nausea and vomiting did not differ. No significant difference was obtained between intravenous paracetamol and propacetamol considering pain relief, pain intensity difference, patient's global treatment satisfaction and between intravenous paracetamol and metamizole on pain scores and pain scores on coughing . Intravenous paracetamol had safety profile similar to placebo. Adults treated with intravenous paracetamol had 9 times lower risk of adverse events (RR = 0.11; 95%CI: 0.05 – 0.24) and 30 times lower risk of infusion site reactions (RR = 0.03; 95%CI: 0.01 – 0.16), comparing with propacetamol. CONCLUSIONS: Intravenous paracetamol is an effective drug in postoperative pain management in children and adults as superior to oral paracetamol and placebo. Its efficacy is comparable to propacetamol and metamizole, with better safety profile.