Background: Effective perioperative pain management is critical for patients undergoing major upper abdominal surgeries. Epidural analgesia, a cornerstone of regional anesthesia, is widely used to manage pain in these surgical cases. Fentanyl and dexmedetomidine are commonly used additives to local anesthetics for epidural analgesia. This trial aims to compare the two additives. Settings and design: The study was a double-blind, randomized controlled study conducted in a tertiary care hospital. Materials and methods: The trial included patients aged 18–65 of either gender who had planned upper abdominal surgery. The patients received an epidural infusion of 0.1% bupivacaine with either dexmedetomidine or fentanyl for postoperative analgesia. Outcome variables included static and dynamic pain on the visual analogue scale (VAS), analgesic consumption, and hemodynamic variables. Each group had 34 patients. Observations: The demographic variables were comparable between the groups. At various time points, the static and dynamic VAS score for pain were significantly lower in the dexmedetomidine group. The analgesic consumption was also lower in the dexmedetomidine group. Hemodynamic variables and complications were similar between the groups. Conclusion: Dexmedetomidine, as an adjuvant to epidural bupivacaine, is better than fentanyl in patients undergoing upper abdominal surgery.