〔Abstract〕 Objective To observe the effect of intranasal administration of low dose dexmedetomidine during epidural puncture in patients with lower extremity fracture on improvement of pain symptoms. Methods A total of 76 patients with lower extremity fracture who underwent continuous epidural anesthesia in the Xiamen Tongan District Hospital of Traditional Chinese Medicine from March 2022 to March 2023 were selected and randomly divided into a control group (continuous epidural puncture anesthesia with routine regimen) and an observation group (routine continuous epidural puncture anesthesia + low dose dexmedetomidine intranasal anesthesia) with 38 cases in each group. The degree of pain during epidural puncture was evaluated in both groups. Results The pain degree during and after puncture in the observation group was lower than those in the control group, and the sedation score was higher that in the control group, the differences were statistically significant (P < 0.05). The heart rate and systolic blood pressure of the observation group after puncture, during operation and after operation were lower than those of the control group, and the differences were statistically significant (P < 0.05). The total incidence of postoperative adverse reactions in the observation group was lower than that in the control group, and the difference was statistically significant (P < 0.05). Conclusion Intranasal administration of low dose dexmedetomidine during continuous epidural anesthesia for patients with lower extremity fractures can effectively reduce the pain of patients during puncture, increase the degree of sedation of patients during anesthesia, reduce the tension during epidural puncture, reduce the fluctuation of blood flow during surgery, and contribute to postoperative recovery of patients.