Introduction: Intravenous regional anaesthesia (IVRA) or Bier’s block is easy to administer, reliable, and cost-effective for short operative procedures of the extremities performed on an ambulatory basis where a local anaesthetic is injected intravenously using tourniquet. Objectives: To compare the effectiveness of i.v paracetamol as add on therapy to lidocaine in Intravenous Regional Anaesthesia with those receiving plain Lidocaine .Methodology:66 patients were randomly and blindly divided into 3 groups. All groups received IVRA lidocaine (3 mg/kg) diluted with saline to a total volume of 40 mL. Group 1 - lidocaine plus IV saline, Group - lidocaine and paracetamol (300 mg) admixture plus IV saline, and Group 3 - lidocaine plus IV paracetamol (300 mg).Sensory and motor block onset time, tourniquet pain, and analgesic use were assessed during operation. Visual analog scale (VAS) scores was used to assess pain. Results: Onset of motor block was shorter and recovery of motor and sensory block was significantly longer in Group 2 (P < 0.05). VAS scores were significantly lower in Group 2 (P < 0.05).Preoperative and postoperative analgesic consumption was significantly less in Group 2 (P <0.05). Conclusion: The addition of paracetamol during IVRA with lidocaine decreased tourniquet pain, increased anaesthesia quality, and decreased postoperative analgesic consumption.