Fifty-seven elderly patients with hip fractures were randomized to receive either a PENG block with 20 mL of 0.5% ropivacaine (n=28) or a sham block (n=29). The primary outcome was the dynamic pain score at 30 minutes postblock. Secondary outcomes included dynamic pain scores at 1, 3, and 24 hours, pain during positioning for spinal anesthesia, and 24-hour opioid consumption. Outcomes were assessed up to 24 hours. Overall, the study revealed that PENG block significantly reduced dynamic pain scores at 30 minutes, 1 hour, and 3 hours, as well as during positioning for spinal anesthesia, and lowered 24-hour opioid use compared with the sham group. The findings suggest that PENG block provides effective early analgesia and an opioid-sparing benefit in elderly patients with hip fractures.