Bring a large pot of well-salted water to a boil. Add the orecchiette and cook according to package instructions until al dente, approximately 8-10 minutes. Reserve a cup of pasta water, then drain the pasta.

In a large sauté pan, melt the butter over medium-low heat. Add the diced red onion and season with salt and pepper. Sauté for about 5-7 minutes until softened.

Stir in the minced garlic and cook for about 1 minute until fragrant. Do not let the garlic burn.

Add the tomato paste to the pan and cook for about 5 minutes, allowing it to darken slightly.

Pour in the vodka and stir. Let it simmer for about 1 minute until the alcohol smell dissipates.

Reduce heat to low and add the heavy cream and red pepper flakes. Mix well and let it simmer for about 2-3 minutes.

Add the drained orecchiette to the sauté pan with a splash of reserved pasta water and toss to combine.

Remove from heat and stir in grated Parmesan until melted and well combined.

Plate the pasta and top with extra Parmesan and fresh basil leaves for garnish.