Proximal femur fractures are common in the elderly and require early surgical fixation for optimal pain relief and recovery. Spinal anesthesia is widely preferred due to its simplicity and lower complication rates, but severe pain during positioning can make its administration difficult. Poorly controlled perioperative pain is associated with delirium, increased morbidity and mortality, and chronic pain, making effective analgesia a top priority.

While opioids such as fentanyl provide adequate pain relief, their adverse effects have encouraged the use of regional anesthesia techniques, including femoral nerve block (FNB) and fascia iliaca compartment block (FICB). Recently, the ultrasound-guided pericapsular nerve group (PENG) block has been introduced as a novel technique targeting the articular branches of the femoral, obturator, and accessory obturator nerves to provide focused hip analgesia.

Although early reports suggest that the PENG block is effective for fracture-related pain, positioning for neuraxial anesthesia, and postoperative pain control, evidence remains limited. This study aims to evaluate the effectiveness of ultrasound-guided PENG block for improving patient positioning and compare its analgesic efficacy with intravenous fentanyl in patients undergoing hip fracture surgery under neuraxial anesthesia.