Background: Monitored Anaesthesia Care (MAC) typically involves administration of local anaesthesia in combination with IV sedatives, anxiolytic and/or analgesic drugs. Present study was aimed to compare middle ear surgeries under sedation and local anaesthesia with midazolam plus dexmed versus midazolam plus nalbuphine. Material and Methods: Present study was a prospective, comparative study conducted in patients 18-60 years age, either gender, ASA Grade I /II, posted for middle ear surgery under Sedation & local anaesthesia. In first group MD, patients received intravenous inj. midazolam 1 mg plus inj. dexmedetomidine 1 ugm /kg bolus and 0.5 ugm kg added in 100 ml NS infusion, given at 0.3 to 0.4 ugm/ min. In second group MN, patients received intravenous inj. midazolam 1 mg plus inj nacphin 10 mg slowly