Background: Effective postoperative pain control remains a major challenge following abdominal hysterectomy performed under spinal anaesthesia. Sedative adjuvants such as dexmedetomidine and midazolam are commonly used to prolong analgesia, provide sedation, and stabilize hemo dynamics, but their comparative postoperative efficacy remains underexplored. Objective: To compare the postoperative analgesic efficacy and sedation profile of intravenous dexmedetomidine versus midazolam in patients undergoing abdominal hysterectomy under spinal anaesthesia. Methods: A prospective, randomized, single-blind study was conducted on 150 ASA I–II patients undergoing abdominal hysterectomy. Participants were randomly divided into two equal groups: Group D received intravenous dexmedetomidine 1 µg/kg, and Group M received intravenous midazolam 0.05 mg/kg, both diluted in 10 ml normal saline. Hemodynamic parameters, Ramsay sedation scores, onset and duration of sensory and motor block, duration of postoperative analgesia, and total tramadol consumption within 24 hours were recorded. Statistical analysis was done using unpaired t-test and Chi-square test, with p Results: The groups were demographically comparable. Dexmedetomidine significantly shortened the onset and extended the duration of sensory block (343.4 ± 43.0 vs 171.5 ± 31.2 min, p Conclusion: Intravenous dexmedetomidine provides superior postoperative analgesia and sedation compared to midazolam without significant hemodynamic instability, making it a preferable adjuvant for abdominal hysterectomy under spinal anaesthesia.