Objective To compare the effects of nerve block combined with laryngeal mask anesthesia, combined spinal⁃epidural anesthesia，and general anesthesia on perioperative inflammatory stress and immune func⁃ tion in elderly patients undergoing total hip arthroplasty. Methods Totally 60 patients who underwent unilateral total hip arthroplasty，including 21 males and 39 females，aged 63 ~ 80 years，with a BMI of 17 ~ 35 kg/m2 ，ASA Ⅱ or above，were randomly divided into nerve block combined with laryngeal mask anesthesia group（group N），combined spinal⁃epidural anesthesia group（group E），and general anesthesia group（group G），with 20 cases in each group. Group N was given lumbosacral plexus nerve block combined with laryngeal mask general anesthesia； group E combined spinal ⁃epidural anesthesia，and group G general anesthesia. After the operation，each group adopted patient ⁃controlled intravenous analgesia（PCIA）. Blood samples of patients in each group were collected before surgery，1 hour and 24 hours after surgery. Enzyme ⁃linked immunosorbent assay（ELISA）was used to detect plasma IL⁃10，cortisol，CRP，IL⁃4，and IFN⁃γ level. VAS pain score was recorded 24 h before surgery，12 h and 24 h after surgery. Results Compared with that in group G，the dose of remifentanil in group N was reduced （P < 0.05）. There was no statistical difference in ephedrine and atropine use among the three groups（P > 0.05）. Compared with those in group G，the plasma IL⁃4 level of groups N and E were reduced after 24 hours of surgery （P < 0.05），and the IFN⁃γ/IL⁃4 ratio increased（P < 0.05）；plasma cortisol level decreased 1 hour after surgery （P < 0.05），and plasma IL⁃10，cortisol，and CRP level decreased 24 hours after surgery（P < 0.05）. Compared with that of group G，the VAS score of group N decreased 12 hours after surgery，showing clinical significance （P < 0.05）. Conclusion Compared with general anesthesia，nerve block combined with laryngeal mask anesthesia and spinal⁃epidural anesthesia can reduce the expression of immune and inflammatory stress⁃related cytokines after total hip replacement surgery in elderly patients，among which nerve block combined with laryngeal mask anes⁃ thesia has better analgesic effect.