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Application for ESRA Abstract Prizes:Background and Aims Managing morbidly obese patients poses significant anesthetic challenges due to associated pathophysiological changes and increased perioperative risk. We report the use of dexmedetomidine for sedation and potential analgesic extension during spinal anesthesia gradual resolution in a patient with class III obesity.Methods A 37-year-old male (ASA III) presented for surgical resection of a thigh mass. He weighed 220 kg with a height of 170 cm (BMI: 76 kg/m 2). His medication included fluoxetine, aripiprazole, liraglutide and naltrexone - bupropion. After explaining the procedure to the patient and obtaining informed consent, spinal anesthesia was performed in the sitting position with a 27gauge, 120 mm needle. A total of 3,2 ml ropivacaine 0,75% was administered intrathecally. Ten minutes later a T4 sensory and a Bromage 3 motor blockade was recorded. At the fifth surgical hour the sensory block had regressed to T12. Intravenous dexmedetomidine was initiated: a bolus of 1 μg/kg actual body weight, followed by an infusion of 0.25 μg/kg/h.Results The patient remained at the desired sedation level until the end of operation that lasted 390 minutes. Arterial blood pressure was reduced by 25% baseline. No adverse effect was recorded.Conclusions Dexmedetomidine, beyond its sedative properties, offers analgesic effects via α2-adrenergic receptors in the spinal cord. This dual action is particularly advantageous in patients with morbid obesity, where opioid-sparing strategies and hemodynamic stability are essential. Our case highlights the safe and effective use of dexmedetomidine in extending comfort during prolonged surgery under spinal anesthesia, without adverse effects.