Objective: To explore the effect of butorphanol tartrate (BT) on elderly patient-controlled intravenous analgesia after total hip arthroplasty (THA) and its effect on the levels of inflammatory factors. Methods: Sixty elderly patients who received THA at Linquan County People’s Hospital between August 2018 and August 2019 were enrolled. Thirty patients who received BT as patient-controlled intravenous analgesia were enrolled in the observation group. Thirty patients who received sufentanil analgesia as patient-controlled intravenous analgesia were included in the control group. At 4 different time points after the operation, the systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), visual analog scale (VAS), Richmond Agitation-Sedation Scale (RASS), the number of effective compressions of the patient-controlled intravenous analgesia pump, and the postoperative analgesic rescue time were compared between the 2 groups. The incidence of adverse reactions in the 2 groups was observed. The levels of interleukin-1β (IL-1β), interleukin-6 (IL-6), C-reactive protein (CRP), and tumor necrosis factor-α (TNF-α) were observed before and after the surgery in the 2 groups. Results: SBP, DBP and HR in the observation group were significantly higher than those in the control group at all postoperative time points (P<0.05). VAS scores in the observation group, which gradually decreased with time, were all lower than 4 points [VAS score (resting): 2.20–3.13, VAS score (dynamic): 2.64–3.97], and were significantly lower than those in the control group [VAS score (resting): 2.96–4.37, VAS score (dynamic): 3.40–4.80, P<0.05]. At each time point after the operation, the RASS scores of both groups were lower than 5 points, and gradually decreased with time. The RASS scores of the observation group (2.13–2.87) were significantly lower than those of the control group (1.56–2.27, P<0.05). Twenty-four hours after the surgery, the levels of inflammatory factors IL-1β [(31.68±3.23) mg/L vs (36.22±2.66) mg/L], IL-6 [(61.80±5.70) pg/mL vs (69.28±5.26) pg/mL], CRP [(19.58±1.57) mg/L vs (24.72±2.28) mg/L] and TNF-α [(3.03±0.27) pg/mL vs (4.09±0.24) pg/mL] in the observation group were significantly lower than those in the control group (all P<0.05) The effective compression times of the patient-controlled intravenous analgesia pump in the control group were significantly more than those in the observation group [(4.37±2.06) h vs (6.33±1.89) h, P<0.05]. The time of secondary rescue analgesia in the observation group was significantly slower than that in the control group [(15.73±3.12) h vs (11.79±2.95) h, P<0.05]. There was no significant difference in the total incidence of adverse reactions between the 2 groups (10.00% vs 16.67%, P>0.05). Conclusion: As a self-controlled venous analgesia, BT has better analgesic effect and higher degree of sedation than sufentanil, and has high safety degree.