BACKGROUND: Hip fractures have become a significant clinical concern on a global scale in recent years. The burgeoning aging population has exacerbated this issue, leading to a rise in the number of hip fracture cases coupled with concomitant geriatric ailments. Therefore, it poses a huge challenge to anesthesiologists with the increasing number of critically ill patients who are not suitable for general anesthesia and intrathecal anesthesia. Ultrasound-guided nerve blocks combined with sedation have not previously been documented in critically ill patients. CASE PRESENTATION: We administered an ultrasound-guided modified iliac fascia block combined with sacral plexus block to an 88-year-old male patient with a left femoral fracture suffering from severe multi-systemic diseases. Concurrently, the patient received intravenous anesthesia via propofol and dexmedetomidine, with monitoring conducted through bispectral index. Subsequently, the surgery was completed smoothly and the patient demonstrated accelerated postoperative recovery without significant discomfort and a successful discharge. CONCLUSIONS: This innovative approach significantly contributed to achieving successful surgical anesthesia and postoperative analgesia, thereby facilitating early recovery and discharge from the hospital. We propose that ultrasound-guided nerve blocks with sedation show promise for critically ill patients.