Am J Emerg Med

Managing hip fracture pain: Nerve block vs. fentanyl

December 10, 2025

A randomized double-blind trial (NCT06862154) of 104 hip fracture patients found that ultrasound-guided femoral nerve block (FNB) with bupivacaine provided superior pain relief compared with IV fentanyl, with greater median pain reduction at 20 minutes (4 vs. 2 points). FNB patients required significantly less rescue analgesia (21% vs. 62%) and experienced no adverse events, while the fentanyl group had notable rates of nausea (23%), dizziness (15%), and hypotension (6%). FNB proved equally effective in cognitively impaired patients, offering a safer alternative to systemic opioids for this vulnerable population.

Clinical takeaway: Consider ultrasound-guided FNB as first-line analgesia for ED patients with hip fractures to achieve superior pain control while minimizing opioid-related complications.

Source:

Altunbaş E, et al. (2026, January). Am J Emerg Med. Femoral nerve block vs IV fentanyl for hip fracture pain in the emergency department: A randomized double-blind clinical trial. https://pubmed.ncbi.nlm.nih.gov/41167010/