Objective: To explore the application of preoperative anesthesia preparation in pediatric hernia surgery under the concept of enhanced recovery after surgery (ERAS). Methods: Sixty children with indirect inguinal hernia who were diagnosed and treated in Xinfeng County People’ s Hospital were selected from January 2024 to February 2025, and were randomly divided into traditional group (n=29) and experimental group (n=31) by envelope double-blind method. Both groups received pediatric hernia surgery under general anesthesia. The traditional group adopted traditional preoperative anesthesia preparation regimen, while the experimental group adopted preoperative anesthesia preparation regimen based on ERAS concept. The preoperative anxiety degree, intraoperative anesthesia effect and postoperative pain rate were compared between the two groups, and the postoperative recovery indicators and incidence rates of postoperative adverse events were recorded. Results: Before surgery, the mYPAS score in experimental group was significantly lower than that in traditional group (P<0.05). During surgery, the remifentanil dosage and incidence rate of intraoperative body movement were significantly lower in experimental group than those in traditional group (P<0.05). After surgery, the pain rate, ambulation time, hospitalization time and incidence rates of postoperative adverse events in experimental group were significantly lower compared to traditional group (P<0.05). Conclusion: In summary, the application of preoperative anesthesia preparation under the concept of ERAS in pediatric hernia surgery can effectively reduce the preoperative anxiety and postoperative pain rate of children, enhance the intraoperative anesthesia effect, and improve the related recovery indicators, and it has high safety.