Epidural anesthesia is a safe and inexpensive technique with the advantage of providing surgical anesthesia and prolonged postoperative pain relief. It is also an effective treatment of operative pain as it blunts autonomic, somatic and endocrine responses. This study showed the effect of adding magnesium sulphate, dexmedetomidine and ketamine to epidural bupivacaine in anesthesia for lower urinary tract surgeries, with respect to onset of action, potency, duration of the block and the total dose of bupivacaine consumption during surgery as well hemodynamic changes. Methods: 80 patients, ASA I/II were enrolled into the study. All patients had epidural anesthesia and randomly allocated into one of four groups. Group C: (20 patients)The patient received 10 ml of bupivacaine 0.5%, Group M: (20 patients): The patient received 10 ml of bupivacaine 0.5% plus 1.0 ml of magnesium sulphate 10% (100 mg) , Group D: (20 patients):The patient received 10 ml of bupivacaine 0.5% plus dexmedetomidine in a dose of 1 μg/kg diluted in 1 ml normal saline and Group K: (20 patients) The patient received 10 ml of bupivacaine 0.5% plus ketamine in a dose of 0.3 mg/kg diluted in 1 ml normal saline. In all groups assessment was done after 10 minutes aiming to achieve T10 sensory level and G3 motor block. Otherwise incremental doses of 5 ml bupivacaine 0.5% were given without additives. Results: This study demonstrated that a more rapid onset of action of the epidural block was achieved in the magnesium group, while in the ketamine and dexmedetomidine groups, a more prolonged duration of action was recorded. In all groups, total dose consumption of the local anesthetic was lower than that of the control group. Hemodynamic variables were stable and there were no significant differences between groups.Conclusion: Magnesium, ketamine and dexmedetomidine are effective as useful adjuvants to local anesthetic for epidural anesthesia. Magnesium sulphate is associated with a shorter onset of action of the epidural block. While both ketamine and dexmedetomidine have a prolonged duration and an increased potency of the block. All the studied drugs effectively decreased the total dose requirements of local anesthetic drugs. No significant side effects were observed throughout the study period.