Ninety elderly patients undergoing total hip arthroplasty were randomized to receive either a pericapsular nerve group (PENG) block (n=30), a lumbar erector spinae plane block (L-ESPB) (n=30), or no block (control group, n=30). The primary outcome was total opioid consumption over 48 hours. Secondary outcomes included pain scores, time to first rescue opioid, quadriceps strength, and inflammatory markers (NLR and PLR). Outcomes were assessed at 3, 6, 12, 18, 24, and 48 hours postoperatively. Overall, the results revealed that both ESPB and PENG blocks significantly reduced opioid consumption and pain scores, prolonged time to rescue analgesia, and lowered stress markers compared to control. ESPB preserved quadriceps strength better than PENG. These findings suggest both blocks enhance recovery, with ESPB offering potential motor-sparing advantages.