Abstract Background: Emergence agitation (EA) of sevoflurane is a problem in preschool children especially when performing certain procedures as strabismus. Adequate postoperative analgesia reduces the incidence of EA. Dextromethorphan as well as paracetamol are two different analgesics that had been used to control acute postoperative pain. Aim of the work: is to compare the effect of preventive analgesia using oral dextromethorphan versus oral Paracetamol on emergence agitation of sevoflurane in preschool children performing strabismus repair. Patients and methods: 150 children ASA I, aged 2-6 years were included in this study. All children received IM 0.01 mg/kg atropine 1 hour before surgery. The children were then randomly assigned into 3 groups: Group D (n=50) were given oral dextromethorphan 0.5mg/kg 1 hour preoperatively, Group P (n=50) were given oral paracetamol 15 mg/kg 1 hour preoperatively. Group C (n=50) were given 10ml oral placebo. Preoperative incidence and score of agitation was recorded (graded on a five-point scale). Inhalational induction of anesthesia was performed using 8% sevoflurane in 100% O2 and maintenance was performed using sevoflurane 1-2%. The following times were recorded for every patient: T0= time of discontinuation of sevoflurane, T1= T0 to the time to extubation, T2= T0 to eye-opening to verbal stimuli, T3= T0 to time of the first supplemental analgesia. Agitation and pain scores were evaluated every 5 minutes with the highest score recorded for every patient. Results: T1 and T2 showed insignificant differences between the three studied groups. The postoperative incidence of EA (score ≥4) was higher in both group P [28%] (14/50) and group C [30%] (15/50), compared to [12%] (6/50) in group D. Post-operative pain scores showed no significant differences between the three studied groups. T3 was significantly longer in groups D and P than control group (77.3±17.3 in group D, and 72.5±16.7 in group P vs 58.8±18.1 min in group C), while it was comparable between groups D and P. Conclusion: Preoperative oral dextromethorphan (0.5mg/kg) significantly attenuates emergence agitation with sevoflurane anesthesia when compared to preoperative oral paracetamol (15mg/kg) following strabismus operations in preschool children. Keywords: Strabismus, Dextromethorphan, Paracetamol, Preschool Child, Emergence agitation, Sevoflurane.