Aims: The aim of this study was to evaluate and compare the efficacy and safety of fentanyl and midazolam given intrathecally with hyperbaric 0.5% bupivacaine in patients undergoing elective caesarean sections. Materials and Methods: A total of 180 women undergoing elective cesarean section were included in a prospective, double-blind, controlled trial. Patients were divided in three groups of 60 each and randomly assigned to receive spinal anesthesia with 2 mL 0.5% hyperbaric bupivacaine with 0.4ml of normal saline ( Group C) , 2 mL 0.5% hyperbaric bupivacaine with 12.5 g fentanyl (Group F) and 2 mL 0.5% hyperbaric bupivacaine with 2mg midazolam (Group M). Each group had a total volume of 2.4ml made by addition of normal saline. Onset and duration of sensory and motor block, duration of postoperative analgesia, hemodynamic effects and adverse effects due to study drugs were recorded and Statistical analysis was done. Results: Duration of analgesia was significantly prolonged in fentanyl group (254.83±14.84 mins.) compared to midazolam group(211.16±15.02 mins) and bupivacaine group (143.16±13.08 mins.) Hemodynamic parameters were comparable in the three groups. Side effects in all three groups were minimal. Apgar score did not differ in 3 groups. Conclusion: 12.5 g fentanyl seems to be a better alternative to 2 mg midazolam as an adjuvant to bupivacaine in patients undergoing elective cesarean section as it prolongs the duration of analgesia without any deleterious effects on the mother and baby.