Regional nerve blocks are associated with greater early analgesia for femoral neck fractures in the emergency department

Femoral neck fractures are highly painful emergency department (ED) presentations, particularly among older adults, and early analgesia is essential for imaging, positioning, and surgical preparation. This prospective, comparative, non-randomized ED study compared intravenous (IV) paracetamol, IV tramadol, ultrasound-guided femoral nerve block (FNB), and ultrasound-guided pericapsular nerve group (PENG) block in adults with isolated femoral fractures, particularly femoral neck fractures. The primary outcome was maximum pain reduction during the 240-minute follow-up. Because baseline pain scores differed between groups, maximum pain reduction was compared using analysis of covariance adjusted for age, fracture type, and baseline pain score. Among 125 patients, 113 (90.4%) had femoral neck fractures. Among 125 patients, 113 (90.4%) had femoral neck fractures. Ultrasound-guided regional blocks were associated with faster and greater pain reduction than systemic analgesics across visual analog, numeric rating, and facial pain scales. The largest early reductions occurred within the first 15 min after the FNB and PENG block. Effect sizes for maximum pain reduction were large on both the visual analog and numeric rating scales. Rescue analgesia was rarely required after regional blocks, whereas adverse events occurred mainly in the opioid group. These findings suggest that ultrasound-guided regional blocks may provide effective early analgesia in similar ED fracture analgesia settings where trained clinicians are available.