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Background and Aims Osteogenesis imperfecta (OI), is a rare autosomal dominant inherited disorder caused by an abnormality in the production of type I collagen, characterised by fragility and bone deformities with multiple fractures caused by minimal trauma. These clinical manifestations not only have an impact on anaesthetic management (risk of intubation and ventilation), but are also linked to surgery to correct the deformities, in particular osteotomies, which are a major source of post-operative pain.the interdisciplinary approach is the cornerstone of the treatment, which has two essential components: Anaesthesia and overall multimodal analgesia as part of early rehabilitation

Methods We will discuss our experience of the intraoperative analgesic management of 25 IO with femoral shaft fractures, undertaken in the operating theatre under GA. Intraoperative analgesia was provided by: Ketamine 0.5mg/Kg and dexamethasone 4mg at induction to prevent postoperative hyperalgesia Paracetamol IV15mg/Kg 30 min before the end of the operation. Musculocutaneous and pericatricial infiltrations (bupivacaine) at the end of the operation. Post-operative NSAIDs and paracetamol every 6 h. Pain assessment using a numerical scale after patients were fully awake and then at H2-H4-H6-H8

Results Significant reduction in post-operative pain without morphine consumption for the duration of the stay

Conclusions the anaesthetic and analgesic approach to OI are specific, Loco-regional analgesia is evolving towards more selective targeted techniques. For optimised multimodal management, echo-guided femoral block cannot be performed (plaster cast applied at the end of the operation), neurostimulation is outlawed (risk of fracture); infiltration remains a simple, virtually risk-free alternative. The benefit/risk ratio is particularly favourable.