Background: Most patients admitted to the surgical ward undergo laparotomy for various reasons, despite the use of analgesics pain control could remain inadequate. Inadequate postoperative pain management can lead to undesired post-operative complications which increases the risk of morbidity and increased hospital stay. This study aimed to determine the prescription pattern of analgesics, inadequacy of postoperative pain management and its associated factors in the first three days among patients undergoing laparotomy at Bugando Medical Centre. Method: Prospective longitudinal study was conducted at Bugando Medical Centre from April to July 2022, involving 106 adult postoperative patients undergone laparotomy and were admitted to the general surgery wards. Structured questionnaires were used to obtain post-operative information. Postoperative pain severity scores were assessed by using a Numerical Rating Scale (NRS). Data were analysed using STATA v.15. Bivariate analysis and multivariate logistic regression were done. A P-value of <0.05 was considered significant. Results: The types of analgesics commonly prescribed postoperatively were a combination of Pethidine and Paracetamol (67.8%), followed by combinations of Pethidine and Paracetamol with Diclofenac (25.2%) and lastly Pethidine, Paracetamol and Tramadol (7.0%). The prevalence of moderate to severe postoperative pain within 12, 24, 48 and 72 hours were 97.7%, 92.2%, 47% and 21.8% respectively. There was a significant association between sex with the severity of pain. Conclusions: Postoperative pain management was inadequately managed at Bugando Medical Centre. The proportion of postoperative pain in the first twenty-four hours post-operative was the highest. There was no uniformity in the postoperative pain management in our setting and a suboptimal prescription of pethidine was noted. The frequency of pethidine prescription was eight hours instead of four to six hours. Male sex was associated .........