Objective To investigate the anesthetic effect of nalbuphine combined with propofol for intravenous anesthesia in rhinoplasty. Methods A total of 80 patients undergoing rhinoplasty in Linyi Central Hospital from January 2022 to January 2024 were selected as the research objects. They were divided into control group and study group by random number table method, with 40 patients in each group. The two groups of rhinoplasty were treated with intravenous general anesthesia + local anesthesia. The control group was treated with propofol + fentanyl, and the study group was treated with propofol + nalbuphine. The anesthesia effect, vital signs, postoperative anesthesia recovery time and adverse reactions, cognitive function and pain degree were compared between the two groups. Results The excellent and good rate of anesthesia in the study group was 100.00%, which was slightly higher than 95.00% in the control group, but the difference was not statistically significant (P >0.05). There was no significant difference in mean arterial pressure and heart rate between the two groups at 5 min after anesthesia (P >0.05). The postoperative spontaneous breathing recovery time, eye opening time and command recovery time in the study group were shorter than those in the control group (P <0.05). After operation, the MMSE and MoCA scores of the study group were higher than those of the control group (P <0.05). The VAS score at 1,2 and 3 h after operation in the study group was lower than that in the control group (P <0.05). The incidence of adverse reactions in the study group was lower than that in the control group (P <0.05). Conclusion The application of propofol combined with nalbuphine in rhinoplasty can ensure the effect of intraoperative anesthesia, maintain the stability of vital signs, promote the rapid recovery of patients after operation, reduce the cognitive impairment and postoperative pain, reduce the incidence of adverse reactions, and have the efficacy and safety of anesthesia.