Forty-six patients (n=46) with end-stage hip disease undergoing THA were randomized to receive ultrasound-guided erector spinae plane block (ESPB) with ropivacaine (n=23) or sham ESPB with normal saline (n=23). The primary outcome of interest was postoperative pain (11-point NRS) in the recovery room and at 12, 24, and 48 hours. Secondary outcomes included intra-operative remifentanil use, mean arterial pressure (MAP) and heart rate (HR) profiles (and coefficients of variation), and postoperative adverse events. Outcomes were assessed up to 48 hours. Overall, the results of the study revealed lower NRS scores through 24 hours and lower intra-operative opioid consumption with ESPB, alongside reduced variability in MAP/HR; differences in NRS were no longer evident at 48 hours and complication rates were similar. These findings suggest ESPB is a useful adjunct to multimodal analgesia for early recovery in elderly THA.