Background: Bilateral sphenopalatine ganglion block (SPGB) and IV clonidine premedication could provide better hemodynamic parameters, surgical field, postoperative pain control during endoscopic sino-nasal surgery. Design: prospectiverandomized controlled comparative study. Methods: A total of 69 patients of ASA grade I or II scheduled for endoscopic sino-nasal surgery were equally divided into three groups (23 patients each): control group; block group; and clonidine group. The sphenopalatine ganglion block technique done by lateral infra-zygomatic approach guided by x-ray fluoroscopy. Iv clonidine premedication was given 15 min before general anesthesia induction with dose 2 µg/kg as singe bolus. Surgical field quality assessment done by average category scale (ACS), hemodynamic profile and consumption of anesthetics were recorded. Postoperative pain evaluated by VAS. The time to first request for analgesia, analgesic requirement for 24 h postoperatively and any complications were recorded. Results: MAP and HR readings at most of intra and postoperative times, Average category scale score, intraoperative blood loss, average consumption of fentanyl and propofol and hypotensive agent (labetalol) were significantly high in control group when compared with block and clonidine groups and were significantly low in block group when compared with clonidine group except for postoperative HR.VASscore postoperatively, Time of first request of analgesia, Total pethidine consumption was significantly high in control group C when compared with block and clonidine groups. Conclusion: SPGB is effective for better hemodynamic control, surgical field and postoperative analgesia in endoscopic sino-nasal surgery when compared with IV clonidine premedication.