Along the past time, researchers are addressing the optimal conditions of parturient female to provide an optimum intraoperative condition with stable hemodynamic, good postoperative analgesia and early ambulation with minimal maternal and foetal side effects targeting enhanced recovery after CS. According to our results, LD- DEX group showed better sensory block, longer postoperative analgesia, less dense motor block with earlier ambulation, stable maternal hemodynamic maintained by lower amounts fluids and ephedrine, and less shivering with no neonatal side effects.
Ginosar et.al., reported ED50 of hyperbaric bupivacaine ranges from 4.8 mg to 9.8 mg and the ED95 ranges from 8.8 mg to 15 mg . Meanwhile we used, throughout our study hyperbaric bupivacaine at dose of 7 mg and 10 µg dexmedetomidine as LD-DEX group versus 12 mg as control group. Dexmedetomidine proved to enhance sensory block and post-operative analgesic effect of IT hyperbaric bupivacaine (P < 0.05 in all except duration of S1 dermatome pain perception P = 0.06). that was supported by other reports in literature. [21–24] The mechanism of action of dexmedetomidine could be due to binding to pre-synaptic C-fibres and post-synaptic dorsal horn neurons which causes decreased release of C-fibres neurotransmitters and hyperpolarization of post-synaptic dorsal horn neurons. [25, 26]
Regarding motor block, our results showed a weak degree of block 2 degree according to modified Bromage score  which is suitable for that LD of hyperbaric bupivacaine and help early ambulation postoperative and regaining the muscle power which is reported to be 206 (60.9) min. and came parallel to 331 (35) min. that is reported by Shukla et.al., using 15 mg hyperbaric bupivacaine and about 221.1 (1.37) min as reported by Fyneface- Ogan et.al., [27, 28]
That decreased dose resulted in more stable maternal hemodynamic profile and subsequently, less IV fluids and ephedrine than used for control group to be maintained, which came parallel to what is reported by Al-Mustafa and colleagues  and El-lakany . Follow up of BP measurements, there was an initial increase in BP lasting for 12 minutes followed by hypotensive episodes with well response to IV fluids and ephedrine. However, that biphasic response had no effect on mean blood pressure which also approved by Kanazi et.al.  taking in consideration different populations of reported studies and different doses of hyperbaric bupivacaine that is used which was 12.5 mg, 17.5 mg, respectively and 7 mg in our study. That 12 minute- hypertensive episode would allow a good time for co-loading and delivery of the foetus decreasing episodes of foetal hypoperfusion due to decreased blood pressure.
As well, shivering in LD- DEX group showed a good profile with incidence of 5% which is much lower (P < 0.05) and came parallel to reports by Abdelhamid and El-lakany , Y. Sun et.al.,  and K. Nasseri et.al.,  Regarding nausea with or without vomiting there is no difference in incidence and is well co-related to episodes of hypotension and peritoneal traction parallel to outlined by Kang et.al.
We encountered several limitations in this study. Firstly, intravenous fluid regimen was not standardized during the surgical procedure and was left up to judgement of the attending anaesthesiologist. However, that had no potential impact on our outcomes. The second limitation was the use of lower concentrations of LA. Nonetheless, the dose of LA and not the volume or concentration is the major determining factor in block height and motor block. Finally, sample size was calculated based on two segment regression as the primary outcome which found to be statistically insignificant, hence, conclusions for others outcomes should be interpreted cautiously.