Objective To compare the effects of desflurane combined anesthesia with combined spinal epidural anesthesia(CSEA)on early postoperative cognitive function in elderly patients undergoing total hip replacement. Methods 66 patients(aged over 65)who underwent the total hip replacement from June 2016 to July 2017 were selected. By computer random sequence method, the patients were randomly divided into desflurane group(group D)and CSEA group(group C). This study adopted MMSE(mini-mental state examination MMSE)to assess patients' cognitive functions during the perioperativeperiod-1 d before surgery, 1 d, 3 d and 7 d after surgery. We also observed the prevalence of postoperative delirium and patient satisfaction with anesthesia. Results The collected data were processed by the method of repeated variance analysis. The results revealed that after operation, the scores of 1 d MMSE in group D and group C were significantly lower than they were before operation(P<0.05), while the score in group D was lower than that in group C(P<0.05). 3 d after the operation, the MMSE scores of group D were still lower than the preoperative level(P<0.05), but were higher than the data of 1 d(P<0.05). However, the scores of these two groups in this period showed no statistical difference. According to the data of 7 d after operation, the scores of two groups basically returned to the preoperative levels, and there was no statistical difference in the incidence of delirium between the two groups(P>0.05). The satisfaction of patients in group D was significantly higher than that in group C(P<0.01). Conclusion There is no significant difference in effects between desflurane anesthesia and CSEA on early postoperative cognitive function in elderly patients undergoing total hip replacement surgery.