Objective To compare the clinical efficacy and safety of ultrasound-guided iliac fascia block combined with lumbosacral plexus block and general anesthesia in hip arthroplasty in elderly patients. Methods A total of 90 elderly patients undergoing hip arthroplasty in Macheng People′s Hospital from October 2017 to October 2018 were enrolled in this study, and randomly divided into observation group and the control group, with 45 cases in each group. General anesthesia was used in the patients of control group, while iliac fascia combined with lumbosacral plexus block was given to those in observation group. Both groups were followed up for 30d post-operatively. The amount of intra-operative sufentanil, amount of drug in intravenous self-controlled pain (PCA), time of getting out of bed, time of discharge, scores of visual analogue scale (VAS) at 4,2 and 24h after operation, peri-operative hemodynamic parameters, cognitive function, and incidence of complications in 30 d after operation were compared between the 2 groups. SPSS statistics 17.0 was used for data analysis. Results The observation group had less intra-operative sufentanil dosage [(12.39±2.44) vs (38.02±5.28)μg], lower drug amount in PCA in postoperative 24h [(58.34±3.59) vs (81.13±4.25)ml], shorter time of getting out of bed [(4.16±0.81) vs (5.34±1.15)d] and discharge time [(7.29±0.76) vs (8.35±0.96)d] when compared with the control group (all P<0.01). But all the scores of mini-mental state examination (MMSE) were significantly higher in the former than the latter group. But the trends in VAS scores were opposite [4h:(0.83±0.15) vs (3.34±0.61); 12h:(1.52±0.31) vs (3.31±0.54); 24h:(1.76±0.35) vs (3.15±0.62), all P<0.05]. The mean arterial pressure (MAP) and heart rate (HR) in the observation group were significantly higher than those of the control group at 10 min after the completion of anesthesia, at the beginning and at the end of operation (P<0.05). After 30d of follow-up, no death occurred in the 2 groups, and the incidence of complications was significantly lower in the observation group than the control group (4.44% vs 31.11%, P<0.05). Conclusion Ultrasonic-guided iliac fascia block combined with lumbosacral plexus block can be applied in hip arthroplasty for elderly patients with high safety, good anesthesia effectiveness, and less impact on the hemodynamics and cognitive function.