Pain control after total hip arthroplasty is associated with patient satisfaction, early discharge, and improved surgical outcomes. Two commonly utilized opioid-reducing analgesic modalities are periarticular injection (PAI) by surgeons and motor-sparing peripheral nerve block (PNB) by anesthesiologists. We present a case contrasting PAI and PNB in a single patient undergoing bilateral total hip arthroplasty. For the left hip, the patient received preoperative transmuscular quadratus lumborum, femoral nerve, and lateral femoral cutaneous nerve blocks using a combination of low-concentration local anesthetic and glucocorticoids. For the right hip, the patient received an intraoperative PAI with liposomal bupivacaine. The patient's pain scores and recovery were evaluated for three months postoperatively. The patient's pain scores on postoperative day (POD) zero to five were consistently lower in the left hip than in the right hip. For this patient undergoing bilateral hip replacement, preoperative PNBs were superior to PAI for postoperative pain control.