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Objective: To compare the application effect of ultrasound-guided medial and lateral approach continuous fascia iliaca compartment block (FICB) in total hip arthroplasty (THA). Methods: 97 THA patients who were treated in our hospital from June 2019to June 2021 were selected as the research objects. According to the random number table method, the patients were divided into lateral group and medial group, with 48 cases and 49 cases respectively. The perioperative indexes, postoperative block related indexes, pain mediators, stress response indexes and adverse reactions were compared between the two groups. Results: There were no differences between the two groups in the amount of intraoperative bleeding, the sufentanil usage, the time of extubation/operation/hospitalization/first out of bed activity and stay in the resuscitation room (P>0.05). The visual analogue scale (VAS) score at 48h after operation in the medial group was lower than that in the lateral group (P<0.05). There was no significant difference in the time of puncture and drug injection between the two groups (P>0.05). The time of catheter placement in the medial group was shorter than that in the lateral group,the number of cases of catheter re fixation was less than that in the lateral group, and the depth of catheter placement was longer than that in the lateral group (P<0.05). The substance P (SP), prostaglandin E2 (PGE2), neuropeptide Y (NPY) and 5-hydroxytryptamine (5-HT)increased at 24 h after operation in the two groups, but the medial group was lower than the lateral group (P<0.05). Cortisol (Cor),C-reactive protein (CRP) and norepinephrine (NE) increased at 24 h after operation in the two groups, but the medial group was lower than the lateral group (P<0.05). There was no difference in the incidence of adverse reactions between the lateral group and the medial group (P>0.05). Conclusion: The ultrasound-guided medial and lateral approach FICB can provide good analgesic block for THA patients, and promote their postoperative recovery. The medial approach has more advantages in alleviating pain stimulation, stress response and catheter operation. [ABSTRACT FROM AUTHOR]