Six randomized controlled trials including 403 elderly patients undergoing hip arthroplasty were included in this systematic review and meta-analysis comparing peripheral nerve block combined with low-dose general anaesthesia versus conventional general anaesthesia alone. Pooled outcomes of interest included postoperative pain scores at 12, 24, and 48 hours, perioperative sufentanil and propofol use, complication rates, and postoperative cognitive function. The combined approach significantly reduced pain scores at 12 and 24 hours, anaesthetic and opioid consumption, and complications, while no significant difference was found at 48 hours post-op. The findings suggest that the combined technique improves early analgesia and perioperative safety in elderly hip arthroplasty patients.