Abstract: Objective: To investigate the application of ultra-low concentration ropivacaine in epidural anesthesia combined with general anesthesia for elderly patients. Methods: 120 elderly patients undergoing elective abdominal surgery were randomly divided into three groups. Patients in general anesthesia group (group I) received general anesthesia, and patients in ropivacaine group (group II) received 0.375% concentration of ropivacaine for epidural. Blocking combined with general anesthesia, patients in the ultra-low concentration ropivacaine group (group III) received 0.1% concentration of ropivacaine for epidural block combined with general anesthesia. The anesthesia of the three groups, basic indicators during anesthesia, adverse reactions after anesthesia, Ramsay sedation score, and simple mental state (MMSE) scores were compared. Results: The doses of propofol, respiratory recovery time, extubation time and recovery time were significantly lower in group II and group III than in group I (P<0.05), but there was no significant difference in propofol dosage between the two groups (P>0.05).The mean arterial pressure (MAP) and heart rate (HR) of group I and group II fluctuated greatly during anesthesia, and the MAP and HR of group III at T2~T5 were lower than group I and group II (P<0.05), and Its indicators fluctuate less. The VAS scores of Group II and Group III were significantly lower than those of the control group (P<0.05). There were no significant differences in MMSE scores between the three groups before operation, which was significantly lower at 1 day after operation and significantly higher at 3 days after operation (P<0.05), and the MMSE scores of group III at 1d and 3d were significantly higher than those at group II (P<0.05). The satisfaction rate of group III was significantly higher than that of group II and group I (P<0.05).Conclusion: Ultra-low concentration ropivacaine and conventional concentration ropivacaine used in epidural anesthesia have similar anesthetic effects in elderly patients undergoing upper abdominal surgery. However, ultra-low concentration ropivacaine.under the premise of satisfying the analgesic effect, improves the stability of vital signs and reduces postoperative cognitive impairment.