Background: This study was  designed  to  evaluate the comparative effectiveness and safety of dexmedetomidine and dexmedetomidine with Butorphanol or Fentanyl for sedation, analgesia, blood less surgical field, patients and surgeons satisfaction in patients undergoing middle ear surgery(MES) under local anaesthesia with Monitored Anaesthesia Care (MAC).

Material & Methods: 90 patients aged 12 to 50 years, ASA class I and II undergoing elective microscopic MES under Local Anaesthesia with MAC were randomized into three groups (n=30). All groups received inj. Dexmedetomidine 1µg.kg^–1 in 100 ml NS as loading dose over 10 minutes and then 0.5 µg/kg/hr as infusion. In group D NS 10ml, group DF inj. Fentanyl 1µg.kg,^–1in NS and in group DB inj.Butarphanol 1mg.kg^–1in NSwas given after Dexmedetomidine bolus.

Results:Ramsay sedation score(RSS) remained higher in group DB and the VAS score remained at lower scalein group DB & group DF.Group DB patients required minimum rescue analgesia. Patients and surgeons were more satisfied in group DB.

Conclusion: We concluded that dexmedetomidine and butorphanol combination is better for intraoperative sedation, analgesia, patient comfort and surgeon satisfaction with bloodless surgical field.