Objective: To investigate the effects of ultrasoundguided realtime precise caudal block combined with laryngeal mask airway (LMA) general anesthesia on intraoperative stress response and postoperative bowel function recovery in patients undergoing vaginal hysterectomy. Methods: This prospective, singlecenter randomized controlled trial enrolled 108 patients who underwent elective vaginal hysterectomy in our hospital from January 2023 to January 2025. They were randomly divided into a control group (n=54) and an observation group (n=54). The control group received LMA general anesthesia alone, while the observation group received ultrasoundguided realtime precise caudal block (0.25% ropivacaine 20 mL) combined with LMA general anesthesia. The following parameters were compared between the two groups: hemodynamic variables [mean arterial pressure (MAP), heart rate (HR)] at different intraoperative time points, stress response indicators [serum cortisol (COR), norepinephrine (NE), blood glucose (GLU)], postoperative bowel function recovery indicators (time to bowel sound recovery, time to first defecation, time to first flatus), postoperative pain Visual Analog Scale (VAS) scores, effective pressing times of patientcontrolled analgesia (PCA) pump, rescue analgesia rate, and incidence of adverse reactions. The primary outcome was the 24 h postoperative VAS score; secondary outcomes included intraoperative stress response indicators and postoperative bowel function recovery indicators. Results: No significant differences were found between the two groups in age, BMI, operative time, or intraoperative blood loss (P>0.05). Compared with T0, MAP and HR at T1, T2 and T3 were increased in both groups, but the MAP and HR at T1, T2 and T3 in the observation group were significantly lower than those in the control group (P<0.05). Levels of COR, NE and GLU at T1, T2 and T3 were higher than those at T0 in both groups, but the levels in the observation group were significantly lower than those in the control group at the corresponding time points (P<0.05). The time to bowel sound recovery, time to first defecation and time to first flatus in the observation group were significantly shorter than those in the control group (P<0.05). The VAS scores at 2 h, 6 h, 12 h and 24 h postoperatively in the observation group were significantly lower than those in the control group (P<0.05); the effective pressing times of PCA pump and the rescue analgesia rate in the observation group were also significantly lower than those in the control group (P<0.05). The incidence of postoperative nausea and vomiting (PONV) in the observation group was significantly lower than that in the control group (P<0.05), whereas no significant difference was observed in the incidence of urinary retention between the two groups (P>0.05). Conclusion: Ultrasoundguided realtime precise caudal block combined with LMA general anesthesia can effectively alleviate intraoperative stress response, maintain hemodynamic stability, promote postoperative bowel function recovery, and improve postoperative analgesia quality in patients undergoing vaginal hysterectomy, without increasing the incidence of adverse reactions. Therefore, this combined anesthesia technique is worthy of clinical application.