Objective: To investigate the impact of preemptive analgesia combined with multimodal analgesia on perioperative pain and postoperative fracture healing in elderly patients with hip fractures. Methods: A total of 202 patients who underwent total hip arthroplasty from January 2024 to December 2024 were selected and divided into two groups based on different analgesic methods: a control group receiving routine postoperative multimodal analgesia and a study group receiving preemptive analgesia combined with multimodal analgesia, each with 101 cases. The analgesic effects were compared between the two groups. Results: The pain scores of the study group at all postoperative time points were significantly lower than those of the control group (P < 0.05); the number of patient-controlled intravenous analgesia pumps and the frequency of rescue analgesia in the study group were significantly lower than those in the control group (P < 0.05); the levels of stress response indicators in the study group were significantly lower than those in the control group after surgery (P < 0.05); the fracture healing time in the study group was significantly shorter than that in the control group (P < 0.05). Conclusion: The application of preemptive analgesia combined with multimodal analgesia in elderly patients with hip fractures can provide superior perioperative analgesic effects, effectively reduce surgical stress responses, promote early functional rehabilitation, and have a positive effect on postoperative fracture healing.