Objective To investigate the effect of ultrasound?guided bilateral superior laryngeal nerve internal branch block combined with endotracheal surface anesthesia in patients with hypertensive cerebral hemorrhage for the duration of postoperative tube insertion. Methods A total of 100 emergency hypertensive intracerebral hemorrhage surgical patients who visited our hospital from October 2021 to April 2023 were included as the research subjects. They were randomly divided into four groups， 25 patients in each group. After surgery， group U received bilateral superior laryngeal nerve internal branch block under guidance of ultrasound combined with endotracheal surface anesthesia， group C1 received bilateral superior laryngeal nerve internal branch block under guidance of ultrasound， group C2 received endotracheal surface anesthesia， and group C3 did not undergo any procedure after surgery. Hemodynamic changes （HR， MAP， and SpO₂） at different time points during the postoperative tube insertion in four groups of patients were recorded. The frequency of restlessness within 10 hours after surgery， the dosage of dexmedetomidine and urapidil， the volume of wound drainage， and the satisfaction of bed nurses were also recorded. Results There was no statistically significant difference in general conditions among the four groups （P > 0.05）. There was no statistically significant difference in HR and MAP at different time points in Group U （P > 0.05）， while the differences among the other three groups were statistically significant （P < 0.05）. At the same time point， the MAP and HR of group U and C1 were significantly lower than those of group C3 （P < 0.05）， and the MAP of group U was significantly lower than that of group C2 （P < 0.05）. There was no statistical difference in SPO2 among the four groups of patients at the same time point （P > 0.05）； The frequency of restlessness， dosage of dexmedetomidine and urapidil， and volume of wound drainage in the U and C1 groups were significantly lower than those in the C2 and C3 groups （P < 0.05）. Except for the difference in restlessness frequency （P < 0.05）， there was no statistical difference in other indicators between group U and C1； There was a statistical difference in satisfaction among the four groups of nurses （P < 0.05， C3 > C2 > C1 > U group）. No nerve block related complications were observed in the U and C1 group. Conclusion Ultrasound?guided bilateral superior laryngeal nerve branch block combined with endotracheal surface anesthesia can maintain hemodynamics steadily of the postoperative patients in the NICU to varying degrees and reduce the frequency of postoperative restlessness， the dosage of sedative and anti?hypertensive drugs， while reducing the flow of wound drainage， and improve the satisfaction of bed nurses.