Objective: To investigate the effect of ultrasound-guided high iliac fascia block on blood coagulation in elderly patients with femoral head replacement. Methods: Eighty elderly patients undergoing femoral head replacement under intravenous general anesthesia were selected. The patients were divided into two groups according to the random number table: observation group (ultrasound-guided high fascia iliac block combined with intravenous general anesthesia group) underwent ultrasound-guided high fascia iliac block followed by intravenous general anesthesia 30 min before anesthesia induction; The control group (intravenous general anesthesia group) only received intravenous general anesthesia, with 40 cases in each group. Venous blood samples were collected at admission (baseline), 1 h and 24 h after operation for thromboelastography analysis. Serum was separated by centrifugation, and the levels of serum cortisol, C-reactive protein (CRP), IL-6 and TNF-α were determined. NRS scores were recorded at 6 h (T1), 24 h (T2) and 48 h (T3) after operation. Postoperative adverse reactions and patient satisfaction scores were recorded. Results: Compared with the control group, the R value of the observation group was increased at 24 h after operation, and MA, α and CI were decreased（P＜0.05）. Compared with those at admission, the R value of the control group at 24 hours after operation was decreased, and MA, α, and CI were increased（P＜0.05）. Compared with the control group, the contents of cortisol, CRP, IL-6 and TNF-α at 1 h and 24 h after operation in the observation group were decreased （P＜0.05）, the NRS scores at rest and during exercise at T1-T3 after operation were lower（P＜0.05）, and the satisfaction degree was higher（P＜0.05）. The incidence of restlessness, nausea and vomiting during the recovery period was low（P＜0.05）.Conclusions: Ultrasound-guided high fascia iliaca block combined with general anesthesia can reduce the stress response and hypercoagulable state during and after femoral head replacement in elderly patients, and provide better postoperative analgesia.