Background: Hip fractures in the elderly population pose significant challenges in perioperative management, prompting exploration of alternative anesthesia techniques. Objective: This study aimed to assess the efficacy and safety of sequential combined spinal epidural (CSE) block in elderly patients undergoing hip fracture surgery. Methods: A prospective study enrolled [n=60] elderly patients (>65 years) scheduled for hip fracture surgery. Patients received CSE block using a standardized protocol. Intraoperative parameters, postoperative pain scores, analgesic consumption, and adverse events were documented. Results: The mean age of patients was 75.4 ± 6.2 years. Intraoperative stability was evidenced by a mean surgery duration of 95 ± 12 minutes and low incidence of complications (hypotension 10%, nausea/vomiting 5%). Postoperative pain scores at 6 hours (VAS 0-10: 3.2 ± 1.5) and 24 hours (VAS 0-10: 2.5 ± 1.2) were well-controlled. Reduced opioid consumption (12 ± 4 mg morphine equivalents) and minimal adverse events (urinary retention 5%, neurological symptoms 2%) were observed. Conclusion: Sequential CSE block demonstrated favorable outcomes in elderly patients undergoing hip fracture surgery, showcasing intraoperative stability, effective pain management, and a low incidence of adverse events. These findings suggest the potential benefits of CSE in this demographic, warranting further investigation and validation.