BACKGROUND: The use of epidural analgesia for the management of postoperative pain has evolved as a critical component of multimodal approach to achieve the goal of adequate analgesia with improved outcome. Epidural analgesia offers superior postoperative pain relief compared with systemic opioids. A major area of research is to compare the risks and benefits of regional versus general anesthesia in elderly surgical patients undergoing operation below level 10th. In this study we compare analgesic effect of epidural Bupivacaine,ketamine,fentanyl and midazolam in elderly surgical patients. METHODS: The present study included 100 patients scheduled for orthopedic surgical procedure with age range between (60-80) years old (25 female and 75 male) patients. It was a clinical trial study where patients were randomly allocated into one of 4 study groups. Group (A); control group: 25 patients Epidural anesthesia: Bupivacaine 0.5% Group (B); 25 patients Epidural anesthesia: mixture of (Bupivacaine 0.5% 10-(as in A) + Fentanyl 5μg/ml);Group (C); 25 patients Epidural anesthesia: mixture of (Bupivacaine 0.5% 10-12ml (as in A) + Ketamine 30mg); Group (D); 25 patients Epidrual anesthesia: mixture of (Bupivacaine 0.5% 10-12ml (as in A) + Midazolam 0.05mg/kg BW); RESULT: In all condition,there was signifcant decrease of pain score,decrease onset of sensory and motor block,increase duration of post-operative anelgesia,&decrease stresss response. CONCLUSIONS: In conclusion, Bupivacaine ketamine, bupivacaine fentanyl and bupivacaine midazolam mixture produced longer duration of post-operative analgesia after orthopedic surgery than bupivacaine alone and increase quality of block, increasing onset of sensory and motor block with fewer side effect.