BACKGROUND: Total hip arthroplasty is a common surgical procedure used to reduce pain and improve hip joint function in patients with advanced hip inflammation. Patient-controlled epidural analgesia is more effective in reducing postoperative anxiety. In addition, combined spinal and epidural anesthesia is associated with a lower incidence of respiratory complications like atelectasis. This retrospective comaprative study compared the post operative analgesic effect and postoperative recovery of intravenous patient-controlled analgesia and patient-controlled epidural analgesia. METHODS: A total of 200 patients received hip arthroplasty from January 2018 to January 2021. The patients were divided into the study group (patient-controlled epidural analgesia group, N = 110) and the control group (intravenous patient-controlled analgesia group, N = 90). Various factors were examined, including the surgical procedure, Ramsay Sedation Scale (RSS), resting visual analogue scale (VAS), Bruggrmann comfort scale (BCS), postoperative recovery, and the prevalence of postoperative adverse reactions. RESULTS: The study group showed statistically significant shorter operation time, respiratory recovery time, eye opening time, extubation time, and orientation recovery time, lower RSS score at 4 h, 8 h, 12 h, 24 h, and 48 h compared to the control group. Similarly, the VAS score in the study group was significantly lower at the same time points after operation. Moreover, the BCS scores in the study group were significantly higher at the same time points after operation. The study group demonstrated statistically significant higher comfort levels and shorter times for first mobilization, first bowel movement, and length of hospital stay compared to the control group. Only four cases in the study group experienced nausea and vomiting, somnolence, dizziness, and respiratory depression, while 13 cases in the control group experienced nausea and vomiting, rash, lower limb fatigue, hypotension, drowsiness, dizziness, postoperative mental disorder, and respiratory depression. CONCLUSION: The results reveal that patient-controlled epidural analgesia offers superior pain relief, lower side effects, better post-operative analgesic effect, and better postoperative recovery. Patient-controlled epidural analgesia shows great promising clinical application potential for anesthesia after total hip arthroplasty.