Ｏｂｊｅｃｔｉｖｅ　To observe the clinical application of ultra-sound guided anterior lumbar plexus combined with buttock epithelial nerve block on elderly patients undergoing hip replacement surgery.　Methods　Sixty elderly patients (range from 60 to 80 years old) scheduled for unilateral hip replacement surgery were randomly divided to anterior lumbar plexus combined with buttock epithelial nerve block group (group A) and anterior lumbar plexus nerve block group (group B) by random number table method. The airways of all the patients were controlled by laryngeal mask airway (LMA) in both groups. The bispectral index (BIS) of patients in both groups was maintained in the range of 45-55. The heart rate, systolic and diastolic blood pressure when cutting were recorded respectively. The dosage of sulfentanyl, Visual Analogue Scale (VAS) score at 1, 6, 12 h and 24 h after surgery were recorded. The period from end of surgery to extubation, first off-bed activity after surgery were evaluated.　Results　The heart rate and blood pressure of patients in group A were less than those indexes of patients in group B at T1, T2, T3 (P<0.05). The averaged dosage using of sulfentanyl of group A was less than the dosage of group B (P<0.05). The periods from end of surgery to extubation and off-bed activity of group A were shorter than the periods in group B (P<0.05). The VAS scores at 1, 6, 12 h after surgery in group A were lower than those scores in group B (P<0.05). 　Conclusions　Compared with anterior lumbar plexus nerve block, ultra-sound guided anterior lumbar plexus combined with buttock epithelial nerve block could help maintain circulation stability, reduce usage of opioids during operation, shorten the period of off-bed activity and the period from end of surgery to extubation and offer better analgesia effect on elderly patients undergoing hip replacement surgery.