Objective: To explore the effect of different anesthesia methods on the hemodynamics and stress response during the stereotactic intracranial hematoma removal of the hypertensive cerebral hemorrhage. Methods 80 patients who underwent the stereotactic intracranial hematoma removal in with the hypertensive intracerebral hemorrhage Handan Central Hospital and the Second Hospital of Hebei Medical University from April 2020 to December 2021 were selected into the study. They were randomly divided into the observation group and the control group, with 40 cases in each group. The patients in the observation group were given the scalp nerve block anesthesia before the stereotactic intracranial hematoma removal, and the patients in the control group were given the local infiltration anesthesia before the stereotactic intracranial hematoma removal. The mean arterial pressure (MAP), heart rate (HR), cortisol (COR), norepinephrine (NE) and epinephrine (E) were compared between the two groups before the anesthesia (T0), scalp cutting (T1), drilling (T2) and suture (T3). The pain levels of the two groups of patients were compared at 1 h, 6 h, and 12 h after the surgery, and the Glasgow Coma Score (GCS) score and neurological impairment score (CCS) scores of the two groups before and after the operation were compared. Results The MAP and HR of the control group at T1, T2, and T3 were significantly higher than those at T0 (P < 0.05), and the MAP and HR of the observation group at T1, T2, and T3 were significantly lower than those of the control group (P < 0.05). Cor, NE and E of the observation group at T1, T2, and T3 were significantly lower than those of the control group (P < 0.05). In the control group, Cor, NE and E at T1, T2 and T3 were significantly higher than those at T0 (P < 0.05). The numerical pain rating scale (NRS) scores of the observation group at 1 h, 6 h, and 12 h after the surgery were significantly lower than those of the control group (P < 0.05). The GCS scores of the two groups were significantly higher at 3 days after the surgery, and the CCS scores were significantly lower than those before the surgery (P < 0.05). Conclusion The scalp nerve block anesthesia in the stereotactic removal of intracranial hematoma in patients with the hypertensive intracerebral hemorrhage has more stable hemodynamics and less stress response. [ABSTRACT FROM AUTHOR]