Sixty patients with proximal femoral fractures were randomized to receive a pericapsular nerve group (PENG) block (n=30) or an femoral nerve block (FNB) (n=30) before positioning for spinal anesthesia. The primary outcome was positional pain during lateral decubitus positioning; secondary outcomes included pain during hip and lumbar flexion, quality of positioning, number of lumbar puncture attempts, and peri-operative complications. Outcomes were assessed ~20 min post-block during positioning for spinal anesthesia. Overall, the results showed lower median positional pain scores with PENG versus FNB for lateral positioning (2 vs 2.5), hip flexion (1 vs 2.5), and lumbar flexion (1 vs 2.0), with no between-group differences in positioning quality or number of spinal attempts. These findings suggest PENG provides superior analgesia for positioning without compromising procedural conditions.