Comparative effectiveness of ultrasound-guided regional nerve blocks for hip fracture analgesia in the emergency department: a systematic review

Hip fracture produces severe acute pain and complicates emergency assessment and transfers. Regional nerve blocks provide targeted analgesia within multimodal treatment. This review compared ultrasound-guided techniques for adults receiving emergency department care. PubMed, Scopus, Web of Science, and Cochrane CENTRAL were searched through 31 May 2026. Two authors independently screened studies and extracted data. Randomized trials comparing emergency department initiated single-injection blocks with another ultrasound-guided block, placebo, or systemic analgesia were synthesized narratively. Fourteen randomized trials evaluated femoral, fascia iliaca, and pericapsular nerve group blocks. Femoral blocks generally improved analgesia and reduced opioid exposure relative to systemic treatment, with neutral findings in one short-term fentanyl comparison. Femoral and fascia iliaca blocks produced similar pain reductions in a direct comparison. Supra-inguinal fascia iliaca block improved movement pain relative to the classical approach. Pericapsular nerve group block improved early pain relief relative to infra-inguinal fascia iliaca block and reduced rescue analgesia relative to sham. Opioid reduction varied across trials, including a fascia iliaca study reporting identical median six-hour morphine consumption. Ultrasound-guided blocks improve early hip fracture analgesia in emergency care. Technique selection depends on comparator, assessment timing, and patient characteristics. Data supports regional analgesia within multimodal pathways, without establishing one universally superior block.