Background: Nasal backing and the actual surgical trauma are responsible for mild to severe postoperative pain following nose operations. Aim: To evaluate analgesic effectiveness of nebulized ketamine against nebulized dexmedetomidine for patients undergoing nose operations. Patients and methods: 105 adult patients for elective nose operations were divided into three groups. Patients in each group were given the drug via nebulization 15 minutes before to surgery; in the case of group D, patients received 50 μg of dexmedetomidine (0.5 ml + normal saline 0.9% up to 3 ml), group K, 50 mg of ketamine (1 ml + normal saline 0.9% up to 3 ml), and group C, 0.9% (3 ml) of normal saline. Hemodynamics, intraoperative opioids, the first-time analgesia was requested, the total amount of postoperative rescue analgesia administered, and side effects were all included in the outcome measures. Version 20 of SPSS was used to code and analyses the data that had been gathered. Results: There was statistically significant (p < 0.05) reduction in intraoperative fentanyl needs in D group < K group < C group and also significant decrease in postoperative ketoprofen needs. The first time to rescue analgesia was delayed (p < 0.05) in D group > K group > C group. Postoperative complications were lower in D and K groups < C group (p < 0.05). Conclusion: Preemptive nebulization of dexmedetomidine produces extremely good analgesia in nasal surgeries, when compared with other groups it can effectively reduce the intra- and postoperative opioid consumption.