Objective To explore the application of manual massage combined with fast-track rehabilitation in the nursing of elderly patients with iliac fascia space block analgesia for orthopedic surgery. Methods A total of 68 elderly patients with iliac fascia space block analgesia for orthopedic surgery admitted to a hospital in Xinyang City from August 2020 to August 2021 were selected as subjects and were assigned to a control group and an observation group using the random number table method

with 34 cases in each group. Patients in the control group received manual massage

and the patients in the observation group received fast-track rehabilitation in addition to the manual massage

and both groups received continuous care for 1 week.The recovery status

the incidence of agitation during the awakening period

the time of awakening score equal to or great than 4 points

the time of regaining consciousness and the satisfaction of nursing were compared between the two groups

and the psychological status [Self-Rating Depression Scale（SDS） score and Self-Rating Anxiety Scale（SAS） score] before and after nursing were compared between the two groups. Results The patients in the observation group had shorter defecation time and time of passage of gas by anus than the control group

and all differences were statistically significant（P<0.05）. The SDS and SAS scores of patients in the 2 groups after nursing were lower than those before nursing

with the observation group lower than the control group

and the differences were statistically significant（P<0.05）. The incidence of agitation during the awakening period was 5.88% in the observation group

which was lower than that of in the control group（26.47%）

and the difference was statistically significant（P<0.05）. The time of awakening score equal to or great than 4 points and the time of regaining consciousness in the observation group were shorter than those in the control group

and the differences were statistically significant（P<0.05）. The nursing satisfaction of patients in the observation group was 100.00%

which was higher than that in the control group（88.24%）

and the difference was statistically significant（P<0.05）. Conclusion Manual massage in combination with fast-track rehabilitation can effectively reduce the incidence of agitation during the awakening period in elderly patients with iliac fascia space block analgesia for orthopedic surgery

shorten the duration of agitation during the awakening period

and improve the negative emotions of patients. These benefits justify a wider application of this procedure clinically.