Background Preoperative resuscitation strategies in patients with hip fracture (HF) are lacking. We aimed to investigate fluid‐responsiveness, peripheral perfusion index (PPI) and blood volume (BV)‐status in patients with HF undergoing resuscitation in the preoperative phase. Methods In a prospective observational study, we evaluated preoperative fluid‐responsiveness, indices of perfusion and BV before and after lumbar epidural analgesia in 50 patients with HF shortly after admittance. Results Initially, 18 (36%) patients were fluid‐responsive (≥10% increased SV in response to 250 ml fluid bolus) and 13 (26%) presented hypovolaemia (deviation of measured BV from estimated BV ≤ 0.9). According to fluid‐responsiveness, no difference in absolute values of cardiac index (CI) (2.7 L 2.1–3.3 vs. 2.8 L 2.3–3.4, p = .5) was seen, but cardiac output (CO) rose significantly in the hypovolaemic patients: 9% 5–18 vs. 1% −3–7, p = .004. After epidural analgesia, 26 (52%) patients were again fluid‐responsive and 15 (30%) were hypovolaemic. CI was now significantly lower in fluid‐responsive patients (2.2 L 1.7–2.7 vs. 2.9 L 2.3–3.5, p = .001). Prior to epidural analgesia, no significant trend towards hypovolaemic patients having lower indices of perfusion was seen. After epidural analgesia, more patients with hypovolaemia presented with PPI≤1.5 (8 (53%) vs. 3 (9%), p = .001) and absolute values of PPI were also significantly lower if IBV was low (1.4 0.9–3.2 vs. 3.2 2.4–4.8, p = .01). PPI correlated with hypovolaemia after epidural analgesia (rho 0.4 0.1–0.7, p = .007). Conclusions Preoperative fluid‐responsivity in HF patients might be attributable to elements of hypovolaemia and sympathetic compensatory ability conjointly, confounding the use of SV‐guided resuscitation. PPI could be associated with BV, which may support clinicians during perioperative haemodynamic optimisation.