Ultrasound-Guided Femoral Nerve Block for Hip Fracture Pain Management in the Emergency Department: A Systematic Review

Objective To systematically review randomized controlled trials (RCTs) evaluating the efficacy and safety of ultrasound-guided femoral nerve block (UGFNB) compared to standard analgesic care for hip fracture patients in the emergency department (ED). Methods A systematic review following PRISMA guidelines searched PubMed, Embase, Scopus, and Google Scholar from inception through January 2026 for RCTs comparing UGFNB with standard care in ED patients with hip fractures. Primary outcomes included pain scores and opioid consumption. Secondary outcomes included time to pain relief, adverse events, and functional outcomes. Results Five RCTs involving 551 patients met inclusion criteria. UGFNB consistently demonstrated superior pain reduction compared to standard care, with median pain score reductions ranging from 2-4 points greater than control groups. Preoperative opioid consumption was reduced by 56-80% in UGFNB groups. Adverse events were predominantly associated with opioid use in control groups, while UGFNB-related complications were rare (zero serious complications across all studies). Conclusions UGFNB provides superior analgesia and reduces opioid requirements compared to standard systemic analgesia in ED patients with hip fractures, with a favorable safety profile. Implementation in routine ED practice appears feasible and beneficial, including in elderly patients with cognitive impairment.