Sixty-six elderly patients with hip fractures were randomized to receive either ultrasound-guided anterior iliopsoas muscle space block (n=29) or supra-inguinal fascia iliaca compartment block (S-FICB) (n=28). Each patient was administered 30 mL of ropivacaine 0.375%. The primary outcome of interest was pain scores during positional changes for neuraxial anesthesia. Secondary outcomes included postoperative pain intensity, inflammatory markers (C-reactive protein [CRP] and interleukin-6 [IL-6]) at 12 and 24 hours postoperatively, and perioperative adverse reactions. Outcomes were assessed at 12 and 24 hours after surgery. Overall, the results revealed that the iliopsoas space block had a faster median onset time and provided lower pain scores during neuraxial anesthesia positioning. At 12 hours postoperatively, pain scores during movement were significantly lower in the iliopsoas space group. Additionally, CRP levels at 24 hours were lower in the iliopsoas group. These findings suggest that the iliopsoas space block offers faster onset, superior dynamic pain control, and potentially reduced inflammation compared to S-FICB.