Background: Spinal anaesthesia is a commonly used regional technique for lower abdominal and lower limb surgeries. Bupivacaine is the most commonly employed local anaesthetic for sub arachnoid block. Perioperative hemodynamic status and post-operative pain relief are important issues with Bupivacaine. Different studies have been conducted to establish best adjuvants to overcome these demerits and so as to enhance bupivacaine induced post-operative analgesia and provide a stable intraoperative condition.rnObjective: To compare analgesic effectiveness of intrathecal morphine + bupivacaine + neostigmine bupivacaine and bupivacaine alone for a patient who undergone lower extremities orthopedics procedurernMethodology: In this institutional based prospective cohort study, 102 patients with American Society of Anesthesiologists (ASA) class I or II status, ageâ‰¥18 who undergone lower extremities orthopedics were grouped into bupivacaine 12.5 with morphine(0.2mg) n=34, bupivacaine 12.5mg with Neostigmine (50mcg), n=34 and Bupivacaine alone group (15mg) based on the decision of responsible anesthetist. Data collection method includes preoperative chart review, intraoperative observation and postoperatively patient interview and chart review. Postoperatively duration & consumption of analgesia, first analgesia request as well as severity of pain using 10cm NRS score were assessed over 24hrs.rnThe data were entered into EPI INFO and transport to SPSS version 22 for analysis of variable using one-way ANOVA, kuruska-walih H rank test, and chi square.rnResults: There was significant difference in maximal level of sensory block, time to maximum sensory and motor block among the three groups. The morphine group had longer time to first rescue analgesics than the neostigmine and bupivacaine group (P