This prospective, randomized, double-blind study compared the effects of dexmedetomidine and remifentanil on haemodynamic stability, sedation and postoperative pain control in the postanaesthetic care unit (PACU). Fifty consecutive patients scheduled for total laparoscopic hysterectomy were randomly assigned to receive infusions of either dexmedetomidine (1 μg/kg) i.v. over 10 min followed by 0.2 - 0.7 μg/kg per h continuous i.v. infusion or remifentanil (0.8 - 1.2 μg/kg) i.v. over 1 min followed by 0.05 - 0.1 μg/kg i.v. per min, starting at the end of surgery to the time in the PACU. Modified observer's assessment of alertness scores were significantly lower in the dexmedetomidine group than in the remifentanil group at 0, 5 and 10 min after arrival in the PACU. Blood pressure and heart rate in the dexmedetomidine group were significantly lower than that recorded in the remifentanil group in the PACU. Dexmedetomidine, at the doses used in this study, had a significant advantage over remifentanil in terms of postoperative haemodynamic stability.