One hundred and sixty patients with unilateral hip fracture were randomized to receive continuous femoral nerve block plus sacral plexus block (n=81) or general anesthesia (n=79). The primary outcome was delayed neurocognitive recovery at 7 days, defined by ISPOCD1 Z-score criteria. Secondary outcomes included postoperative nausea/vomiting, pulmonary infection, moderate/severe pain (VAS≥4), opioid consumption (0–48 h), intraoperative hypotension, and 6-month mortality. Outcomes were assessed at 7 days (cognitive battery), during the index hospitalization (complications), and to 48 h for analgesia, with survival tracked to 6 months. Overall, the nerve block group had lower delayed neurocognitive recovery, less hypotension, fewer pulmonary infections, less PONV, less moderate/severe pain, and dramatically lower opioid exposure. No deaths occurred by 6 months. These findings suggest locoregional anesthesia meaningfully reduces early postoperative cognitive decline and complications after hip fracture surgery.