Aim: To compare the effects of injecting ropivacaine 0.75% alone with injecting ropivacaine 0.75% plus dexmedetomidine in lumbar epidural anesthesia for vaginal hysterectomies. Materials and Methods: This observational study, conducted in the Department of Anesthesia, included 100 adult female patients scheduled for elective vaginal hysterectomies under lumbar epidural anesthesia. Participants were classified as ASA class I and II, aged 25 to 65 years, and had weights between 50 to 70 kg. Patients were randomly divided into two groups: Group R (n=50), receiving 20 ml of 0.75% ropivacaine, and Group RD (n=50), receiving 20 ml of 0.75% ropivacaine combined with dexmedetomidine (1 µg/kg). Patients were excluded if they were unwilling to undergo regional anesthesia, obese (BMI > 30), or had psychiatric illnesses, contraindications to epidural anesthesia, ASA class III or IV, or allergies to the study drugs. Sensory and motor block characteristics, hemodynamic stability, sedation levels, and complication rates were evaluated and compared between groups. Results: Group RD showed a faster onset of sensory and motor blocks, with sensory onset at 8.3 ± 1.5 minutes compared to 10.5 ± 1.8 minutes in Group R (p = 0.03) and motor onset at 9.6 ± 1.9 minutes compared to 12.8 ± 2.2 minutes in Group R (p = 0.02). The duration of sensory and motor blocks was also prolonged in Group RD, with sensory duration at 220.7 ± 18.5 minutes versus 180.4 ± 15.2 minutes in Group R (p = 0.04) and motor block duration at 195.3 ± 16.7 minutes versus 160.6 ± 14.8 minutes (p = 0.03). Higher sensory block levels were achieved in Group RD, with 24 patients reaching T4 compared to 14 in Group R (p = 0.05). Group RD demonstrated stable hemodynamic parameters with lower blood pressure and heart rates over time, and significantly higher sedation scores, reaching 4.2 ± 0.9 at 120 minutes compared to 2.1 ± 0.9 in Group R (p = 0.01). However, Group RD also experienced a higher incidence of bradycardia (20.00% vs. 12.00%, p = 0.03) and hypotension (24.00% vs. 14.00%, p = 0.02). Conclusion: The addition of dexmedetomidine to ropivacaine in epidural anesthesia significantly enhanced both the onset and duration of sensory and motor blocks, providing superior sedation and more stable hemodynamic parameters. While Group RD benefited from a more profound anesthetic effect, this group also exhibited a higher incidence of bradycardia and hypotension, indicating that additional monitoring is necessary to manage potential cardiovascular side effects.