One hundred twenty elderly patients undergoing total hip arthroplasty were randomized to receive a subanesthetic dose of esketamine combined with hip capsule peripheral nerve block (n=40)(Group A), esketamine with lumbar plexus block (n=40)(Group B), or esketamine for general anesthesia (n=40)(Group C). The primary outcomes of interest were onset time of anesthesia, duration of block, postoperative recovery time, and postoperative extubation time. Secondary outcomes included mean arterial pressure, heart rate, Visual Analog Scale (VAS) scores for pain, Ramsay Sedation Scale (RSS) scores, and postoperative adverse reactions. Outcomes were assessed up to 24 hours postoperatively. Overall, the results of the study revealed that patients in the hip capsule block group had faster recovery, more stable hemodynamics, better postoperative analgesia, and fewer adverse reactions. These findings suggest that esketamine combined with hip capsule peripheral nerve block may be a superior anesthetic approach for elderly patients undergoing THA.