This study aimed to compare the clinical effects of hyperbaric ropivacaine alone and in combination with dexmedetomidine for spinal anesthesia in elective lower limb orthopedic procedures. A prospective, randomized, double-blind study was conducted on 100 patients undergoing elective lower limb orthopedic surgeries. Patients were randomly allocated into two groups: Group R received hyperbaric ropivacaine 0.75% (3 mL)+0.5 ml normal saline(total volume 3.5ml), and Group RD received hyperbaric ropivacaine 0.75% (3 mL) with dexmedetomidine (10μg) (total volume 3.5ml). The onset and duration of sensory and motor block, hemodynamic parameters, time to first analgesic request, and side effects were recorded. Results showed that the addition of dexmedetomidine to hyperbaric ropivacaine significantly prolonged the duration of sensory and motor block (p < 0.001), extended the time to first analgesic request (p < 0.001), and provided better intraoperative conditions compared to ropivacaine alone. Hemodynamic parameters remained stable in both groups, with no significant differences in side effects. This study concludes that the addition of dexmedetomidine to hyperbaric ropivacaine for spinal anesthesia in lower limb orthopedic procedures provides superior analgesia and prolonged motor and sensory block without significant hemodynamic alterations or increased side effects.