Objective To investigate the clinical efficacy of dexmedetomidine (DEX) combined with pentazocine intravenous anesthesia in percutaneous kyphoplasty (PKP) for osteoporotic vertebral compression fracture (OVCF) in the elderly.Methods A retrospective case-control study was performed to analyze 63 elderly OVCF patients treated with PKP and admitted to Tianjin Hospital from June 2018 to December 2018.There were 20 males and 43 females,aged 65-86 years [(74.7 ± 1.1)years].There were 15 patients with thoracic compression fractures and 48 with lumbar compression fractures,in whom the vertebral height loss was ＜ 30％ without posterior ligament complex damage.Nineteen patients received local anesthesia with lidocaine (Group A),21 patients received intravenous anesthesia with pentazocin and propofol (1 mg/kg) (Group B),and 23 patients received intravenous anesthesia with pentazocin and DEX (0.5 μg/kg) (Group C).Heart rate,systolic blood pressure,respiratory rate and blood oxygen saturation (SPO2) were recorded at 5 time points:at rest in the operating room (T0),after intravenous injection of pentazocine (T1),when the balloon dilated (T2),after the injection of cement (T3),and blinking after being called or at the end of the operation (T4).The levels of plasma cortisol were recorded before and at T3 in three groups.Visual analogue score (VAS) at T4 was recorded.The operation time,patient satisfaction and incidence of adverse reactions were recorded.The wake-up time and orientation recovery time of groups B and C were recorded.Results The heart rate,mean systolic blood pressure,respiratory rate in Group A at T2,T3 and T4 were higher than those in Groups B and C (P ＜ 0.05),but there was no significant difference between Groups B and C (P ＞ 0.05).There was no significant difference in SPO2 at only time among the groups (P ＞ 0.05).No significant differences were found in cortisol between the three groups before surgery.The cortisol level of Group A at T3 was higher than those of Groups B and C with significant difference (P ＜ 0.05),but no significant difference was found between Groups B and C (P ＞0.05).The VAS in Group A was significantly higher than those in groups B and C (P ＜ 0.01).The operative time in Group A was longer than those in Groups B and C (P ＜ 0.05),but no significant difference was found between Groups B and C (P ＞ 0.05).There was no significant difference in patient satisfaction between Groups B and C,and both of them were higher than Group A (P ＜0.01).There was no significant difference in the incidence of adverse reactions between the three groups (P ＞ 0.05).The wake-up time and orientation recovery time of Group C were shorter than those of Group B (P ＜ 0.01).Conclusion For elderly OVCF patients,pentazocin combined with propofol or DEX can be applied in PKP,which has satisfactory analgesic effect,slight effect on respiratory and circulatory,less adverse reactions,and good patient feedback.DEX has more advantages of awakening and orientation recovery and is worthy of clinical application.