The objective of this study was to compare the effectiveness and safety of two different drug combinations used for monitored anesthesia care (MAC) in tympanoplasty procedures. The first combination consisted of pentazocine and phenergan, while the second combination included pentazocine and dexmedetomidine. A prospective, randomized controlled trial was conducted on patients scheduled for tympanoplasty surgery. A total of 100 patients were randomly assigned to either the pentazocine-phenergan group or the pentazocine-dexmedetomidine group. The primary outcome measured included the level of sedation achieved, pain scores during surgery, and the incidence of adverse events such as respiratory depression, nausea, vomiting, bradycardia and hypotention. The results showed that the pentazocine-dexmedetomidine combination achieved a higher sedation score and lower pain scores compared to the pentazocine-phenergan combination. Sedation score in Group PP mean RSS of 1.928571429, while Group PD had a higher mean RSS score of 3.142857143 also VAS scores in Group PP mean VAS sore of 4.542857143, and Group PD had mean VAS score of 3.285714286. However, higher incidences of adverse events were noted in Group PD compared with Group PP. In conclusion, this comparative study suggests that the pentazocine-dexmedetomidine combination may offer superior sedative effects and better analgesia compared to the pentazocine-phenergan combination during tympanoplasty with manageable adverse effects.