Fifty patients with femoral fractures were randomized to receive either fascia iliaca compartment block (FICB) with 0.4 mL/kg of 0.5% plain bupivacaine and adrenaline (n=25) or intravenous analgesia with paracetamol (15 mg/kg, max 900 mg) and tramadol (1 mg/kg, max 100 mg) (n=25). The primary outcome of interest was pain reduction measured by the numerical rating scale (NRS) at 30 minutes and summed pain intensity difference at 4 hours (SPID-4). Secondary outcomes included patient satisfaction and the occurrence of adverse events. Outcomes were assessed over a 4-hour period. Overall, the results revealed that the FICB group experienced significantly better pain relief, as shown by a greater reduction in NRS at 30 minutes (p < 0.00001) and higher SPID-4 scores (p < 0.0001). Patient satisfaction was also higher in the FICB group (91.7% vs. 24%, p < 0.0001). No serious adverse events were reported, though hypoxia and nausea were more common in the intravenous analgesia group. These findings suggest that FICB provides superior pain control and greater patient satisfaction with fewer adverse effects compared to intravenous tramadol and paracetamol for preoperative femoral fracture pain management.