Acute pain represents a challenge for the emergency physician, due to its prevalence and clinical implications. Paracetamol, widely used for moderate pain, is often administered parenterally, long considered more effective. However, recent studies have shown that it is not superior to the oral route, in terms of efficacy and rapidity of action.Our aim was to compare the two routes of paracetamol administration in the management of moderate acute pain in emergency setting.This was a prospective, interventional, randomized, single-center study conducted over a six-month period,enrolling patients aged 18 and over, consulting for moderate acute pain in the emergency department of Taher Maamouri Hospital of Nabeul.After consent, participants were randomized into two groups: IV (1 g paracetamol infusion) and PO (1 gparacetamol effervescent). The primary endpoint was a VAS ≤ 3 at 30 minutes in each group. Secondary endpoints were safety and use of rescue analgesia.One hundred and fifty patients were included (IV: n=75; PO: n =75) with a gender ratio of 1.3 and a mean age of 50±19 years. Mean VAS at T0 was 4.71±0.6 cm with no significant difference (p=0.591). A VAS ≤3 at T30 was obtained in 45 patients in the IV group and 44 patients in the PO group, with p=0.868. There was no significant difference between the two groups in the difference in mean VAS, and in the significant decrease of 10 mm at T30. Sixty-one patients required rescue analgesia at T30, with no difference between the 2 groups (p=0.868). No major adverse events were noted. Minor adverse events were comparable between the two groups at T30 and T60. Six patients in the IV group had an injection-site complication.Clinical and hemodynamic parameters, pain reduction, and need for rescue analgesia were comparable between oral and IV paracetamol. Oral administration avoids injection-related discomfort, with similar safety and efficacy, supporting its use as a practical alternative for moderate acute pain in emergency settings.Our study showed that oral paracetamol was non-inferior to injectable paracetamol in the treatment of moderate acute pain in emergency departments. Further randomized, double-blind studies are needed to validate our results.