Introduction: Anesthesia management for high-risk elderly patients with hip fracture is challenging, it is significant to choose a more minimally invasive anesthesia technique for them than using conventional methods, like general anesthesia and neuraxial anesthesia. Patients concerns: Herein the patient suffered from the right intertrochanteric fracture, combined with heart failure, renal failure at the stage of uremia and pneumonia in her upper left lung Diagnosis: Because of right intertrochanteric fracture, internal fixation with proximal femoral intramedullary nail was scheduled for this patient Interventions: Ultrasound-guided "hourglass-pattern" fascia iliac block combined with sacral plexus and gluteal epithelial nerve block were performed to a high-risk elderly patient Outcomes: The surgery in our report was successfully completed with our effective anesthesia technique and no perioperative complication occurred Conclusion: Ultrasound-guided "hourglass-pattern" fascia iliac block combined with gluteal epithelial nerve block and sacral plexus block not only satisfied the anesthesia and provided effective postoperative analgesia of hip operation, but also has minimal invasion to high-risk elderly patients, and contributed to enhancing recovery after surgery