Background: Intravenous regional anesthesia (IVRA) is an anesthetic technique for surgical procedures on the body's extremities where a local anesthetic is injected intravenously. Objective: To compare between the intravenous regional anesthesias using lidocaine only and lidocaine plus dexmedetomidine as regards onset of sensory and motor block, intraoperative hemodynamic effects, onset of tourniquet pain and postoperative pain assessment. Patients and Methods: This study included 60 patients of both sex admitted for forearm surgeries carried out at Al-Azhar University Hospitals (El-Hussein and Bab El-Sha'arya). They were randomly allocated into two equal groups. Group I: lidocaine group received only lidocaine. Group II: received lidocaine plus dexmedetomidine. The following parameters were assessed between the two groups: onset of sensory and motor block, hemodynamics (MAP, HR and SpO2), onset of tourniquet pain and postoperative pain scoring. Results: There is a statistically significant increase of the mean of Group II compared to Group I according to onset of sensory block (min). Also, there was a statistically significant increase mean of Group II compared to Group I according to onset of motor block (min). Conclusion: Dexmedetomidine as adjuvant to lidocaine in intravenous regional anesthesia produces early onset of sensory and motor block, delayed onset of tourniquet pain, lower postoperative visual analogue score, longer duration of postoperative analgesia.