Objective To explore the hemodynamic effects of iliac fascia block anesthesia guided by B-ultrasound combined with nerve stimulator during hip surgery in the elderly. Methods From May 2019 to May 2022, 40 elderly patients who underwent hip surgery were selected and analyzed retrospectively. They were divided into a control group and an observation group according to anesthesia methods. Twenty patients in the control group received intraspinal anesthesia, and 20 patients in the observation group received B-ultrasound combined with nerve stimulator guided iliac fascia block anesthesia. The anesthetic effect, hemodynamics [diastolic blood pressure （DBP）, systolic blood pressure （SBP）, heart rate （HR）, and blood oxygen saturation （SpO₂）] levels were compared between the two groups. Results The total effective rate was 95.00% in the observation group, which was lower than 100.00% in the control group, with no statistical significance （P>0.05）. The levels of DBP, SBP, HR, and SpO₂ in the observation group were higher than those in the control group after 30 min of anesthesia （P<0.05）. Conclusion The use of B-ultrasound combined with nerve stimulator-guided iliac fascia block anesthesia in elderly hip surgery can make the hemodynamic level of patients fluctuate less, and its anesthesia effect is good, but the spinal anesthesia is better.