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No sponsorships or competing interests have been disclosed for this article. Objective. Tonsillectomy surgery is associated with severe postoperative pain that usually requires analgesics including opioids. Pain control is still a big problem after tonsillectomy surgery. We aimed to evaluate the efficacy of preemptive analgesia using montelukast for pediatric post-tonsillectomy pain management. This is the first-time use of montelukast in post-tonsillectomy pain. Study Design. Double-blind, controlled-randomized study. Settings. University teaching and research hospital. Subjects and Methods. A total of 60 children, aged 5 to 15 years, American Society of Anesthesiologist class I-II, sched-uled for elective tonsillectomy were enrolled in this clinical trial study. The patients were randomized into 2 groups: the montelukast group (group M, n = 30) and control group (group C, n = 30). Group M recieved an oral montelukast tablet and group C recieved placebo at 2400 PM on the morning before surgery. Post-tonsillectomy pain was evalu-ated with the Wong-Baker FACES Scale during the 24 hours after surgery. Patients ’ intraoperative hemodynamic para-meters and intraoperative and postoperative complications were recorded. Results. There were statistically significant differences between group C and group M for Wong-Baker FACES pain rating scale scores (P \.05). In the 24 hours after surgery, the total number of patients using rescue analgesics was higher in group C than in group M, and the difference was statistically signifi-cant (P \.001). There was no significant difference in demo-graphic parameters (P..05). There were no significant differences in postoperative nausea and vomiting, otalgia, tris-mus, fever, or halitosis between the groups (P..05). Conclusion. Preemptive montelukast can be used safely to reduce the serious pain caused by tonsillectomy in children