Regional anesthesia is the preferred mode of anesthesia for major abdominal surgeries in
present times. Gynecological surgeries are often associated with severe pain requiring a
well-planned analgesia regimen to ensure adequate patient-comfort, early mobilization, and to
decrease stay time in the hospital/post-anesthesia care unit (PACU) enabling patients to
return to their normal activities quicker. Dexmedetomidine has been approved by Food and Drug
Administration (FDA) as a short-term sedative for mechanically ventilated intensive care unit
(ICU) patients as it has a sedative effect without significant respiratory depression ,
anxiolytic, analgesic, antihypertensive and sympatholytic properties. Epidural administration
of preservative free midazolam induces antinociceptive effects in humans, when midazolam is
added it acts through gamma amino-butyric acid (GABA) receptors and enhances the affinity of
GABA receptors. Midazolam is involved in the release of endogenous opioids acting on spinal
delta receptors so antinociceptive effects of morphine like substances are potentiated when
epidural midazolam is added. Studies have revealed that use of epidural midazolam provides
effective analgesia in adults. So, the present study will evaluate the additive analgesic
effects of epidural midazolam in combination with bupivacaine in elective gynecologic
surgeries and compare the results with the use of bupivacaine with dexmedetomidine and
observe the quality of epidural anesthesia with occurrence of side effects.