Aim: To compare the efficacy and recovery outcomes of dexmedetomidine-opioid and lidocaine-based anesthetic protocols in managing postoperative pain in patients undergoing abdominal surgeries. Material and Methods: This prospective, randomized, controlled trial included 100 patients aged 18–65 years, classified as ASA physical status I–II, and scheduled for elective abdominal surgeries under general anesthesia. Patients were randomized into two groups: Group D-O (Dexmedetomidine-Opioid) received dexmedetomidine and fentanyl, while Group L (Lidocaine-Based) received lidocaine as part of their anesthetic protocol. Postoperative pain was assessed using the Visual Analog Scale (VAS) at multiple time points. Recovery outcomes, including time to extubation, Modified Aldrete Score ≥ 9, postoperative nausea and vomiting (PONV), and patient satisfaction, were also evaluated. Morphine consumption was recorded as a secondary outcome. Results: Both groups had comparable baseline demographics. Group D-O demonstrated significantly lower VAS scores at all postoperative time points (p < 0.001) and required less morphine for rescue analgesia (4.8 ± 1.1 mg vs. 7.3 ± 1.3 mg, p < 0.001). Recovery times, including extubation and achieving Aldrete Score ≥ 9, were similar between groups. However, Group D-O reported lower PONV incidence (10% vs. 22%, p = 0.11) and significantly higher patient satisfaction scores (9.1 ± 0.6 vs. 8.4 ± 0.7, p < 0.001). ANOVA confirmed significant differences in pain scores between groups (F = 68.9, p < 0.001). Conclusion: The dexmedetomidine-opioid combination provided superior postoperative analgesia, reduced opioid consumption, and improved patient satisfaction compared to the lidocaine-based protocol, with comparable safety and recovery outcomes. These findings highlight the efficacy of multimodal analgesia strategies in abdominal surgeries.