Objective：To investigate the safety and efficacy of butorphanol combined with dexmedetomidine in vertebroplasty under local anesthesia in elderly patients. Methods：Sixty patients scheduled to undergo elective percutaneous vertebroplasty （PVP） were enrolled and randomly assigned into two groups，dexmedetomidine + butorphanol group（ DB group，n=30）and dexmedetomidine + normal saline group （DS group，n=30）. All patients received intravenous infusion of dexmedetomidine before operation （loading dose：0.5 μg·kg-1，maintenance dose：0.5 μg·kg-1·h-1）. Simultaneously，patients in DB group were given intravenous injection of butorphanol 15 μg·kg-1，while patients in DS group were given intravenous injection of the same volume of normal saline. The mean arterial pressure （MAP），heart rate （HR），VAS and Ramsay scores were recorded 5 min after entering the operation room （T0），at the time of changing of positon （T1），trocar insertion （T2），cement injection （T3） and the end of operation （T4）. The intraoperative adverse events were also recorded，such as respiratory depression and bradycardia. Results：Compared with DS group，the MAPs were lower at T1~T4 and HRs were lower at T1~T3（P<0.05）；the Ramsay score between DS group and DB group at T0~T4 were similar （P>0.05）； however，the VAS scores in DB group were lower at T1~T2 than that in DS group （P<0.05）. There was no statistical difference existed when comparing the adverse events，such as respiratory depression and bradycardia，among two groups （P>0.05）. Conclusion：Dexmedetomidine combined with butorphanol could be safely used in vertebroplasty under local anesthesia. It could help to maintain the hemodynamic stability，reduce pain intensity and did not increase the incidence of adverse events during surgery.