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Background and Aims This study aimed to evaluate the analgesic effectiveness and perioperative outcomes of paravertebral block (PVB) using 0.25% bupivacaine alone versus 0.25% bupivacaine combined with dexmedetomidine in patients undergoing atypical lobectomy.Methods Thirty patients undergoing atypical lobectomy were randomly assigned to two equal groups. Group A received a single-shot US-guided paravertebral block with 0.25% bupivacaine (20 ml), while Group B received the same concentration and volume of bupivacaine combined with 50 µg of dexmedetomidine. All patients underwent general anesthesia.Parameters assessed included demographic and intraoperative data, fentanyl consumption, postoperative pain using the visual analog scale (VAS) at 1 and 3 hours, duration of analgesia, and type of surgical procedure. Statistical comparisons were made using appropriate tests, with a significance level of p < 0.05.Results The mean age in Group A was 56.9 ± 8.47 years, and in Group B it was 54.7 ± 8.70 years (p = 0.489). The male-to-female ratio was 9:10 in Group A and 7:10 in Group B. ASA physical status II- III. The mean duration of surgery was 135.0 ± 49.93 minutes in Group A and 137.0 ± 50.21 minutes in Group B (p = 0.914).None of these differences were statistically significant.Pain scores at 3 hours postoperatively were significantly lower in Group B (1.9 ± 1.13) compared to Group A (5.5 ± 1.55), p = 0.000. The duration of analgesia was significantly longer in Group B (9.3 ± 1.01 hours vs. 4.8 ± 1.10 hours, p = 0.001). No significant differences were found in VAS at 1 hour, intraoperative fentanyl use.Conclusions The addition of dexmedetomidine to bupivacaine in paravertebral block significantly enhances the quality and duration of postoperative analgesia in patients undergoing atypical lobectomy. This combination is a safe and effective strategy to optimize pain management in thoracic surgery.