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Background: The erector spinae plane block (ESPB) is a modern interfascial block method to reduce postoperative pain. Dexmedetomidine (DEX), when utilized as an adjuvant to bupivacaine, is believed to enhance analgesia and prolong the period of various anesthetic strategies. Objective: This study aimed to estimate the impact of adding different doses of DEX to ultrasound-guided ESPB (UG-ESPB) on postoperative analgesia following laparoscopic sleeve gastrectomy (LSG). Patients and Methods: A prospective double-blinded randomized study included 72 patients, aged 20-60 years, ASA II-III, undergoing LSG under general anesthesia. Patients were divided into 3 groups: Group A (control group) received ESPB with 20 ml of 0.25% bupivacaine, group B received ESPB with 20 ml of 0.25% bupivacaine + DEX 0.5 µg/kg and group C that received ESPB with 20 ml of 0.25% bupivacaine + DEX 1 µg/kg. Bilateral UG-ESPB was provided before the surgery at the T7 vertebral level. Intraoperative total fentanyl requirements, postoperative pain, hemodynamic parameters, and patient satisfaction were evaluated. Results: Groups B and C had significantly delayed time to the first analgesic requirement and decreased total ketorolac and morphine consumption compared to group A. Intraoperative fentanyl requirements were similar across groups. Ramsay sedation scores were higher in groups B and C. Side effects like bradycardia, hypotension, and nausea were not significantly different among groups. Conclusions: Adding DEX (0.5 or 1 µg/kg) to bupivacaine in UG-ESPB for LSG significantly enhanced analgesic outcomes, provided higher sedation scores, and maintained better hemodynamic parameters without increasing intraoperative fentanyl requirements or postoperative complications. This makes it a valuable adjunct in pain management protocols, with the 1 µg/kg dose showing superior results. [ABSTRACT FROM AUTHOR]