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Background and Aims The fracture of the upper end of the femur (FESF) is a frequent pathology considered to be one of the 10 main causes of disability in the world 1 2 affecting adults and increasingly the elderly are associated with intense pain requiring the use of high levels of perioperative opioids, which increases the risk of adverse effects and consequently the length of stay. Regional anaesthetic techniques are essential to reduce opioid consumption and improve functional recovery. Pericapsular Nerve Group Block (PENG) is a novel approach targeting the articular branches of the femoral, obturator and accessory obturator nerves while sparing the quadricipital motor system. The aim is to evaluate it efficacy in reducing perioperative opioid consumption as part of an Enhanced Recovery After Surgery protocol.Methods We conducted a prospective observational study including 156 patients undergoing hip fracture surgery under unilateral spinal anesthesia and preoperative ultrasound-guided PENG block. Pain scores (NRS), total opioid ; time to mobilization, and opioid-related adverse effects were assessedResults The mean duration for PENG block performance was 8.56 ± 3.18 minutes. The block was well tolerated, with no major complications. Pain scores decreased significantly within 15 minutes post-block (mean NRS < 2).At the time of positioning for unilateral spinal anaesthesia, 98.7% of patients had mild pain (EN ≤ 3).Opioid-free postoperative analgesia was achieved in 89.7% of patients during the first 48 hours. Early mobilization was achieved within 24 hours in over 85% of cases. The incidence of opioid-related side effects was notably low.Conclusions The PENG block offers effective, opioid-sparing analgesia for femoral neck fractures, supporting its integration into ERAS pathways. Its technical simplicity, safety profile, and motor-sparing effect make it a promising option in geriatric orthopedic anesthesia.