Objective To explore the application value of ultrasound-guided fascia iliac block combined with sacral plexus block during elderly hip surgery. Methods A total of 178 elderly patients undergoing hip surgery in our hospital from August 2018 to August 2021 were enrolled and served as the study subjects. According to anesthesia methods, they were divided into combined block group (ultrasound-guided fascia iliac block combined with sacral plexus block anesthesia, n=92) and hypobaric unilateral spinal anesthesia (HUSA) group (n=82). Propensity score matching was used to select 52 pairs of patients with matched baseline data in a ratio of 1∶1. Nerve block time, pain degree, hemodynamic parameters, stress indicators and incidence of complications were compared between the two groups. SPSS statistics 20.0 was used for data analysis. Depending on data type, student′s t test, repeated measures analysis of variance, orχ² test was employed for intergroup comparison. Results The rate of dopamine use and its average dosage were significantly lower in the combined blockade group than the HUSA group (both P<0.05). The combined block group had obviously longer onset times and durations of analgesic effect for both sensory block and motor block than the HUSA group (both P<0.05). The pain visual analog scale (VAS) scores at T1 (lateral position), and 12 and 24 h after surgery were notably lower, while the scores at T2 (skin incision) and T4 (end of surgery) were remarkably higher in the combined block group than the HUSA group (all P<0.05). The morphine dosage in the combined blockade group was less than that in the HUSA group at 0-24 h and 24-48 h after surgery (all P<0.05). The combined block group had lower mean arterial pressure (MAP) at T1, and higher MAP at T3 (30min after operation) and T4 when compared with the HUSA group (P<0.05). The MAP at T2, T3, and T4 in the combined block group were decreased than that at T0 (enter the operating room)(P<0.05); The MAP at T1 in the HUSA group was significantly higher than that at T0 (P<0.05), while the MAP at T2, T3, and T4 were significantly lower than that at T0 (P<0.05). The heart rate (HR) at T1 in the combined block group was lower than that in the HUSA group (P<0.05). The HR of HUSA group at T1 was significantly higher than that at T0 (P<0.05). The blood glucose and plasma cortisol levels were lower in the combined block group than the HUSA group in 24 h after surgery (P<0.05). The incidences of postoperative urinary retention, nausea and vomiting, dizziness and headache in the combined block group were lower than those in the HUSA group (P<0.05). Conclusion Ultrasound-guided fascia iliac block combined with sacral plexus block can maintain intraoperative hemodynamic stability, control postoperative pain, and reduce stress response and postoperative complications.