Aim: To compare effectiveness of Dexmedetomidine with Pentazocine ­ Promethazine combination for intraoperative sedation under MAC for tympanoplasty under local anesthesia (LA). Methodology: Total 120 patients undergoing tympanoplasty under LA divided in to two groups randomly to receive either IV dexmedetomidine 1 g/kg over 10mins followed by 0.2 g/kg/h infusion (Group D) or Pentazocine 0.6mg/Kg and Inj. Promethazine 0.5 mg/kg IV diluted in 10ml normal saline over 10mins followed by 0.2 g/kg/h infusion of normal saline (Group P). Sedation was titrated to RSS of 3. Vital parameters like HR, BP, SpO2, requirement of rescue analgesics, intraoperative bleeding scale, surgeon satisfaction score (Likert Scale) and Post Anesthesia Recovery Score (Modified Aldrete Score) were recorded and analyzed. Results: Intraoperative HR and MAP in Group D were lower than the baseline values and corresponding values in Group P (p<0.05). Intraoperative sedation in Group D was more than Group P (4 vs. 2 in a scale of 6). Intraoperative bleeding scale and surgeon satisfaction score was better in Group D than Group P (median interquartile range (IQR) 9 (8­10) vs. 8 (6.5­9.5) and 9 (8.5­9.5) vs. 8 (6.75­9.25), p = 0.0001 for both). Mean VAS for pain was more in group D than group P. Time for rescue analgesic was high with Group P while modified Aldrete score was high in Group D. Rate of occurrence of adverse drug reaction (ADR) was not statistically significant among two groups (p > 0.05). Conclusion: Dexmedetomidine is comparable to pentazocine ­ promethazine combination for sedation and analgesia in tympanoplasty with better surgical field and surgeon satisfaction, with better hemodynamic stability.