Background: Various intrathecal additives are added to local anesthetics to increase the speed of onset, improve the quality, and prolong the inuence of spinal anesthesia. Midazolam has a synergistic effect on postoperative analgesia when administered intrathecally with bupivacaine. Opioids such as fentanyl are extensively used as an adjunct to local anesthetics in neuraxial blockade to enhance the duration of postoperative analgesia. Aim: The aim of our study was to compare the effects of intrathecal midazolam(1mg) and fentanyl (25 micrograms) as additives to intrathecal hyperbaric bupivacaine 0.5% (15mg) with spinal anesthesia.Materials and Methods: Prospective, observational study was conducted at SRI SIDDHARTHAMEDICAL COLLEGE AND RESEARCH INSTITUTE,TUMKUR. from 1st Jan 2021 to 30th June 2022 on 94 patients. Results: In Bupivacaine and Midazolam group, mean duration of surgery was 84 ± 12.3 minutes and in Bupivacaine and Fentanyl group, mean duration of surgery was 92 ± 14.4 minutes. In Bupivacaine and Midazolam group, mean time for onset of sensory block was 7.1 ± 0.9 minutes and in Bupivacaine and Fentanyl group, mean time for onset of sensory block was 6.9 ± 1.1 minutes. In Bupivacaine and Midazolam group, mean time for onset of motor block was 7.6 ± 1.3 minutes and in Bupivacaine and Fentanyl group, mean time for onset of motor block was 8.1± 1.2 minutes. In Bupivacaine and Midazolam group, mean duration of sensory block was 213.6 ± 16.1 minutes and in Bupivacaine and Fentanyl group, mean duration of sensory block was 218.3 ± 19.2 minutes. Conclusion- The onset of sensory and motor blockade was comparable in Fentanyl with Bupivacaine and Midazolam with Bupivacaine. Additional of intrathecal Fentanyl prolonged the duration of analgesia signicantly than that of Midazolam. There was signicantly less consumption of rescue of analgesia among patients with Fentanyl with Bupivacaine than Midazolam with Bupivacaine. The duration of postoperative analgesia was also signicantly prolonged in the fentanyl and midazolam groups