Background: The use of ultrasound as a guide for regional anesthesia has become common practice and a new challenge to anesthesiologists. Besides its benefits of reduced complications, it also helps in reducing the total anesthetic dose required with higher block success rates. There is also the advantage of direct observation of the pattern of anesthetic spread. Objective: To compare between dexamethasone and dexmedetomidine as adjuvants to bupivacaine in rectus sheath block applied during pediatric abdominal surgeries. Patients and methods: This prospective randomized study was conducted at Mansoura University Children Hospital. We included a total of 60 pediatric patients undergoing elective abdominal surgery. The study was conducted over the period of two years, starting from January 2019 till December 2020.  Results: The mean age of the included patients was 4.7, 4.7, and 4.6 in groups C, D, and Z respectively. Operative time and duration of anesthesia did not show any significant difference between the three groups. The duration of analgesia showed a highly significant difference between the three groups. Group Z showed its superiority as it had a mean analgesic duration of 15.3 hours, followed by Group D which had mean value of 13.02 hours. Conclusion: Both dexamethasone and dexmedetomidine were efficient adjuvants to local anesthetics as they were associated with significant prolongation of the duration of analgesia, decrease in postoperative analgesia, and better patient satisfaction compared to bupivacaine alone.