Twelve randomized controlled trials involving 1157 elderly patients with hip fractures were included. Patients were allocated to receive nerve block–based analgesia or intravenous analgesia. Nerve block techniques included femoral nerve block, fascia iliaca block, and pericapsular nerve group block, delivered as single-shot or continuous catheter techniques, while intravenous analgesia consisted primarily of systemic opioids. The primary outcomes of interest were pain scores 2 hours after intervention and supplemental opioid consumption. Secondary outcomes included pain scores at multiple postoperative time points and the incidence of opioid-related and block-related adverse events. Outcomes were assessed from within 1 hour up to 72 hours post-intervention. Overall, the results of the study revealed that nerve blocks significantly reduced pain scores at all measured time points, particularly within the first 24 hours, and were associated with lower opioid requirements and fewer adverse events. These findings support the clinical value of nerve blocks in elderly patients with hip fractures.