VATS has the potential to have a pain scale and stress response comparable to thoracotomy. The SAPB technique is one of alternative to thoracic epidural, but the ability to control the stress response is still not optimal. Administration of dexmedetomidine as an adjuvant to local anesthesia theoretically enhances the block's effectiveness in pain management and stress response control by reducing the inflammatory mediators. Aim: This study aims to investigate the effect of combining dexmedetomidine with ropivacaine in a serratus anterior plane block (SAPB) on inflammatory response and opioid dosage in patients undergoing video-assisted thoracoscopic surgery (VATS). Material and Methods: This is a double blinded, prospective analytical experimental study conducted on VATS patients at RSUD Dr. Soetomo from January to March 2024. We divided 40 subjects into two groups, groups R and RD. Following anesthesia induction, the RD group received SAPB with ropivacaine 0,375% plus adjuvant dexmedetomidine 1 mcg/kg. We analyzed the IL-6 and NLR values before the incision, 6 hours, and 24 hours after the incision. We also analyzed the total fentanyl dose during surgery, and post operative morphine demand. Results: At the 6th hour, the percentage increase in IL-6 was significantly lower in the RD group compared to the R group, but at the 24th hour, there was no significant difference. The NLR comparison test revealed that the RD group experienced a lower percentage increase in NLR at 6 hours after incision, but no significant difference at 24 hours. Total intraoperative fentanyl requirements and postoperative morphine demands were also significantly lower in the RD group. Conclusion: Adjuvant dexmedetomidine in SAPB with local anesthetic ropivacaine can help control the expression of stress response at 6 hours post-incision, but is not effective at 24 hours. Post-incisional opioid use was also lower.