BACKGROUND:Epidural anesthesia and combined spinal-epidural anesthesia are commonly used approaches for surgical anesthesia in elderly patients, and each has their advantages and disadvantages. Suitable anesthesia approach can stabilize the cycle, reduce the surgical risk and complications, and improve the success rate of treatment. OBJECTIVE:To analyze and compare the anesthesia effect of epidural anesthesia and combined spinal-epidural anesthesia in the elderly patients during hip arthroplasty, and explore the effect of different approaches on the on hemodynamics. METHODS:80 elderly patients undergoing hip arthroplasty were randomly divided into experimental group and control group, with 40 cases in each group. The experimental group received combined spinal-epidural anesthesia. The control group received epidural anesthesia. The mean arterial pressure, central venous pressure, and heart rate variability at each time point, sensory and motor block onset and recovery times, each block plane after 30 minutes of anesthesia, Bromage score of motor block, and anesthetic effects in both groups of patients were compared. RESULTS AND CONCLUSION:The mean arterial pressure at 5 minutes, 30 minutes of anesthesia and after surgery in the control group was significantly lower than the experimental group at the same time point and before anesthesia (P<0.05). The heart rate at 5 minutes, 30 minutes of anesthesia and after surgery in the control group was significantly higher than that before anesthesia and the experimental group at the same time point (P<0.05). The central venous pressure at 5 minutes, 30 minutes of anesthesia and after surgery in the control group was significantly higher than that before anesthesia and the experimental group at the same time point (P<0.05). Sensory and motor block onset time in the experimental group was significantly shorter, while the sensory and motor block recovery time was significantly higher than the control group (P<0.01). After patients in the two groups were anesthetized for 30 minutes, each block plane and Bromage score of motor block showed no significant difference (P>0.05). Anesthetic effect in the experimental group was significantly better than the control group(χ2=5.691 7, P=0.017 0<0.05). Compared with epidural anesthesia, the combined spinal-epidural anesthesia can reduce hemodynamic changes in patients with hip replacement surgery, and has better anesthesia effect.