Aim:The study aimed to compare the clinical efficacy of isobaric ropivacaine alone, ropivacaine-fentanyl, and ropivacaine-dexmedetomidine in spinal anesthesia for vaginal hysterectomy, focusing on sensory and motor block characteristics, postoperative analgesia, and adverse effects. Material and Methods:This prospective, randomized, double-blind study included 120 female patients scheduled for elective vaginal hysterectomy. Patients were randomly assigned into three groups: Group R (ropivacaine 15 mg), Group RF (ropivacaine 15 mg with fentanyl 25 µg), and Group RD (ropivacaine 15 mg with dexmedetomidine 5 µg). Primary outcomes included the onset and duration of sensory and motor blocks. Secondary outcomes were hemodynamic stability, duration of analgesia, and adverse effects. Results:Group RF showed a significantly faster sensory block onset (3.15 ± 0.40 minutes) compared to Group R (3.80 ± 0.95 minutes) and Group RD (3.70 ± 1.00 minutes) (p = 0.001). The duration of sensory block was longest in Group RD (429.25 ± 10.50 minutes) compared to Group R (305.50 ± 27.40 minutes) and Group RF (325.10 ± 24.50 minutes) (p = 0.001). Group RD also exhibited the longest motor block duration (360.50 ± 16.60 minutes) compared to the other groups. Both fentanyl and dexmedetomidine provided enhanced analgesia, but dexmedetomidine showed superior postoperative pain relief without significant adverse effects. Conclusion:The addition of fentanyl and dexmedetomidine to isobaric ropivacaine improves the clinical efficacy of spinal anesthesia in vaginal hysterectomy. Fentanyl offers a faster onset, while dexmedetomidine extends the duration of both sensory and motor blocks, making it suitable for prolonged surgeries with superior postoperative analgesia.