Postoperative delirium is defined as an acute change with cognitive status characterized by fluctuating consciousness and unattention occurring within 30 days after operation. Postoperative delirium is a common complication of surgery in elderly people, but have been often unrecognized, under-diagnosed, under-treated, and under-investigated. We present a case of postoperative delirium in elderly patient who should have been treated with psychotherapy and antipsychotic drugs in psychiatric department after combined epidural-general anesthesia with continuous epidural bupivacaine and fentanyl infusion for postoperative pain control.