This randomized controlled study aims to evaluate the effects of preoperative dexmedetomidine and tramadol on perioperative anxiety, postoperative pain, sedation, and hemodynamic parameters in patients undergoing hemorrhoidectomy under saddle spinal anesthesia with low-dose hyperbaric bupivacaine.

Preoperative anxiety levels will be assessed using the State-Trait Anxiety Inventory (STAI), and postoperative pain will be evaluated using the Visual Analog Scale (VAS) at predefined postoperative time points. Intraoperative hemodynamic parameters, sedation levels, and rescue sedative requirements will also be recorded and compared among the study groups.

This prospective, randomized, double-blind, controlled study is designed to investigate the effects of preoperative dexmedetomidine and tramadol on perioperative anxiety, postoperative pain, sedation, and intraoperative hemodynamic parameters in patients undergoing elective hemorrhoidectomy under saddle spinal anesthesia.

Eligible patients aged 20-60 years with ASA physical status I-II scheduled for elective hemorrhoidectomy will be enrolled. After obtaining written informed consent, patients will be randomly allocated into three groups: dexmedetomidine group, tramadol group, and control group.

Patients in the dexmedetomidine group will receive 1 µg/kg dexmedetomidine administered intravenously as a loading infusion over 10 minutes prior to spinal anesthesia.

Patients in the tramadol group will receive 1 mg/kg tramadol administered intravenously as a loading infusion over 10 minutes prior to spinal anesthesia.

The control group will receive 10 mL of 0.9% saline intravenously over 10 minutes before spinal anesthesia as placebo.

All patients will undergo saddle spinal anesthesia using 1.5 mL (7.5 mg) of 0.5% hyperbaric bupivacaine administered intrathecally via the L4-L5 interspace.

Preoperative anxiety will be assessed using the State-Trait Anxiety Inventory (STAI). Postoperative pain will be evaluated using the Visual Analog Scale (VAS) at predefined postoperative time points. Intraoperative hemodynamic parameters, including heart rate and blood pressure, will be recorded throughout the procedure. Sedation levels and rescue midazolam requirements will also be recorded.

The primary outcome of the study is the change in STAI-State (STAI-S) scores over time among study groups.

Secondary outcomes include postoperative pain scores, intraoperative hemodynamic changes, sedation levels, and rescue sedative requirements among the groups.

Immediate postoperative pain measurements will be recorded; however, because residual spinal anesthesia effects are expected during the early postoperative period, primary postoperative pain analyses will primarily focus on later postoperative time points.

Inclusion Criteria:

Patients aged between 20 and 60 years ASA physical status I-II Scheduled for hemorrhoidectomy under spinal anesthesia Provided written informed consent

Exclusion Criteria:

ASA physical status III or higher Age below 20 or above 60 years Patients who refused or were unable to provide informed consent Known allergy to dexmedetomidine or tramadol Severe hepatic or renal disease Coagulopathy or contraindication to spinal anesthesia

The study is conducted in a double-blind manner. Study medications are prepared in identical opaque syringes by an anesthesiologist not involved in outcome assessment. Participants and investigators responsible for perioperative assessments are blinded to group allocation throughout the study period.