Objective To investigate the analgesic effect and safety of propacetamol combined with patient controlled intravenous analgesia (PCIA) in the elderly over 75 years with hip fracture. Methods A total of 216 patients over 75 years suffering from hip fractures and undergoing surgical treatment in our hospital from June 2015 to June 2016 were recruited in this study. Then the patients were randomly divided into the observation group and control group, with 108 patients in each group. The patients of the observation group were given propacetamol combined with PCIA after operation, while those of the control group only PCIA. The analgesic effect, PCIA sufentanil consumption, and incidence of adverse reactions were observed within 12 h after operation. The effect of analgesia was evaluated by visual analogue scale (VAS) and Ramsay scores. SPSS statistics 17.0 was used to perform the statistical analysis. Quantitative data were compared with variance analysis, and categorical data with Chi-square test. Results In 2 h after surgery, VAS and Ramsay scores were not statistically different between two groups. In 6 h and 12 h after surgery, the observation group had significantly lower VAS and higher Ramsay scores compared with the control group (P<0.05). When compared with the control group, the observation group had significantly less PCIA sufentanil consumption in 2,6 and 12 h after surgery, with significant difference in 6 and 12 h time points (P<0.05). The observation group had obviously lower incidence of opioid-related adverse reactions than control group (8.7% vs 37.0%, P<0.05). Conclusion Combined application of propacetamol and PCIA can effectively offer better pain relief postoperatively, reduce sufentanil consumption, and especially decrease the adverse effects caused by opioids in the over-75-year-old patients after hip fracture surgery.