**Summary**

**Background**: Postoperative pain, nausea, and vomiting (PONV) are common complications following third molar (wisdom tooth) extraction, often necessitating effective pain management strategies. Oral preemptive analgesia, administered before surgery, is hypothesized to reduce these postoperative symptoms by mitigating the central sensitization associated with surgical trauma.

**Objective**: This randomized controlled clinical trial aimed to evaluate the efficacy of oral preemptive analgesia in reducing postoperative pain, nausea, and vomiting following third molar extraction.

**Methods**: A total of 129 participants, aged between 18 and 35 years, who required the surgical removal of impacted third molars, were recruited and randomly assigned into two groups. Group A (n=65) received a single dose of oral preemptive analgesic 30 minutes before surgery, while Group B (n=64) received a placebo. Postoperative pain levels were assessed using the Visual Analog Scale (VAS) at 6,12 and 24 hours post-surgery. The incidence and severity of nausea and vomiting were recorded using the Numeric Rating Scale (NRS) and monitored over a 24-hour period postoperatively.

**Results**: Group A reported significantly lower VAS pain scores compared to Group B at 6, 12, and 24 hours post-surgery (p<0.05). The incidence of nausea and vomiting was also markedly reduced in Group A, with fewer participants requiring rescue antiemetics compared to Group B (p<0.05). Additionally, participants in Group A demonstrated a quicker return to normal activities.

**Conclusion**: Preemptive oral analgesia significantly reduced postoperative pain and the incidence of nausea and vomiting following third molar surgery. This strategy could improve patient comfort and recovery, suggesting its utility as part of routine perioperative management in oral surgery.