Objective: To observe the anesthetic effect of 3 anesthetic schemes for elderly patients undergoing surgery of hip fracture, so as to optimize the strategy of anesthesia. Methods: Ninety elderly patients undergoing internal fixation surgery of hip fracture, aged 80–92 years, with American Society of Anesthesiologists (ASA) II or III, were randomly assigned into 3 groups (n=30): a supra-inguinal fascia iliaca compartment block combined with sacral plexus block group (group S), a lumbar plexus combined with sacral plexus block group (group L), and a combined spinal and epidural anesthesia group (group C). In group S, supra-inguinal fascia iliaca compartment block was performed with 0.375% ropivacaine 40 mL, and sacral plexus block was performed with 0.375% ropivacaine 20 mL. In group L, lumbar plexus block was performed with 0.375% ropivacaine 40 mL and sacral plexus block was performed with 0.375% ropivacaine 20 mL. In group C, combined spinal and epidural anesthesia was performed with 0.5% ropivacaine 2.5 mL. Dexmedetomidine was injected during the surgery. The loading dose of dexmedetomidine was 0.5 μg/kg, and the maintenance dose was 0.25 μg/(kg·h). The mean arterial blood pressure (MAP) and heart rate (HR) of the patients were recorded at operation room admission (T0), positioning (T1), 3 min after anesthesia (T2), 5 min after the anesthesia (T3), 10 min after the anesthesia (T4), 30 min after the anesthesia (T5), skin incision (T6), 60 min after the anesthesia (T7), and 120 min after the anesthesia (T8). The visual analogue scale (VAS) were recorded at T0, T1, T6, 12 hours after the surgery (T9), and 24 hours after the surgery (T10). The time of anesthesia, the time of surgery, the amount of bleeding, volume of fluid infusion, consumption of dexmedetomidine, consumption of vasoactive agents, and rescue analgesia were recorded. Adverse events such as local anesthetic poisoning, nerve injury, vascular injury, and total spinal block were recorded. Results: Compared with group C and group L, the time of anesthesia, MAP, HR and VAS at T1 were decreased in group S (P<0.05). Compared with group C, volume of fluid infusion, application rate of ephedrine, HRs at T2, T3, and VAS scores at T9, T10 were decreased in group S and group L (P<0.05). Compared with group C, consumption of dexmedetomidine, and MAPs at T2, T3, T4 were increased in group S and group L (P<0.05). There was no statistically significant difference in term of the time of surgery, the amount of bleeding, application rate of atropine, the rate of rescue analgesia, VAS scores at T0, T6, and the incidence of adverse events (P>0.05). Conclusion: Ultrasound-guided supra-inguinal fascia iliaca compartment block combined with sacral plexus block is easy to operate. It could alleviate the pain caused by position change, and maintain hemodynamic stability. Therefore, it could be effectively used in anesthesia of hip fracture and postoperative analgesia for elderly patients.