Background Endoscopic nasal surgeries are commonly associated with mild to moderate postoperative pain owing to both nasal packing and surgical trauma itself. Aim To compare the analgesic efficacy of pre-emptive nebulized ketamine versus nebulized lidocaine in patients undergoing these surgeries. This was a randomized controlled clinical trial. Materials and methods A total of 60 adult patients scheduled for elective endoscopic nasal surgeries were randomly allocated in three groups (20 patients each). Patients in each group were nebulized 15 min before the surgery with the respective study drug, that is, ketamine group (group K) patients received ketamine 50 mg; lidocaine group (group L) received lidocaine 2% (40 mg), and control group (group C) received normal saline 0.9%. The outcome measures included hemodynamics, intraoperative opioids, sedation, time of first request for analgesia, the total dose of postoperative rescue analgesia given, and adverse effects. The collected data were coded and analyzed using SPSS version 20. Results Lidocaine group showed the least hemodynamic changes to laryngoscope and intubation at 1, 3, 5, and 10 min after intubation, with no significant differences among the three groups from 15 min after intubation till extubation time. Intraoperative propofol and fentanyl doses were statistically significantly higher in group C compared with groups K and L, with no statistical significant difference between groups L and K themselves. The time to first analgesic request prolonged significantly in groups K and L (255.25±18.45 and 242.50±12.82 min, respectively) when compared with group C (119.75±18.88 min). Diclofenac consumption was significant lower in groups K and L (87.75±9.66 and 91.25±7.23 mg, respectively) compared with C group (150 mg), with no statistically significant difference between both treated groups. Conclusion Nebulization with ketamine or lidocaine before induction of general anesthesia is efficacious, enhances postoperative analgesia, and reduces total doses of rescue analgesics used following endoscopic nasal surgeries