Dexmedetomidine as an Adjuvant During Dural Puncture Epidural

The study aimed to determine the effects of using varied doses of DEX on the concentration of bupivacaine injected for epidural labor analgesia, and to assess the benefits of the dural puncture epidural.

Inclusion Criteria: * Women who attend the Emergency Department in labor, with cervical dilation of 3-5 cm, * normally presented singleton fetus, intact fetal membranes, and who are free of exclusion criteria Exclusion Criteria: Abnormal fetal presentation or lie, 'premature rupture of membranes, maternal fever, fetal distress, pregnancy-induced diseases * abnormal placental position, * ASA grade\>II * marked obesity, * allergy or contraindications to the used drugs, * spinal deformity or disorders 'cutaneous diseases or infection at the injection site