Background: Bariatric surgery is associated with significant postoperative challenges, including pain and nausea. Dexmedetomidine (Dex), an alpha-2 adrenergic agonist, is commonly used to manage pain and postoperative nausea and vomiting (PONV) in various surgical settings. This meta-analysis evaluates the efficacy of Dex in bariatric surgery patients, focusing on postoperative pain intensity, opioid consumption, and PONV. Methods: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) published between 2010 and 2023, assessing Dex use during or after bariatric surgery. Studies comparing Dex to placebo or standard care were included. Data extraction was performed independently by two reviewers, and statistical analysis was conducted using a random-effects model. Study quality was assessed using the Cochrane Risk of Bias tool. Results: Six RCTs (485 participants) met the inclusion criteria. Dex significantly reduced intraoperative fentanyl use (SMD −1.33, 95% CI [−2.19, −0.47], p = 0.002). Pain scores showed mixed results, with some studies reporting lower pain intensity in the Dex group, while others found no significant difference compared to morphine or placebo. PONV scores were generally lower in the Dex group (p = 0.01) compared to placebo and morphine. No significant differences were found in morphine consumption (SMD −1.13, 95% CI [−2.24, 0.01], p = 0.05) or recovery time. Conclusions: Dexmedetomidine appears to reduce opioid requirements and postoperative nausea in bariatric surgery patients. However, the variability in pain management outcomes suggests that further well-designed RCTs are needed to confirm its overall efficacy. The findings are based on moderate-quality evidence, and further research should aim to standardize dosing protocols and patient populations.