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Background and Aims In this study, we aimed to compare the patients who received pericapsular nerve block (PENG) or intrathecal opioid added to low-dose spinal anesthesia in proximal femoral nail (PFN) surgery to be performed due to hip fracture in terms of block efficiency, duration of motor and sensory blockade, postoperative analgesia and opioid side effects in the postoperative period.Methods After the approval of the ethics committee of our hospital and the written informed consent of the patients in our clinic, 60 patients with ASA I-II-III and between the ages of 18–85 were included in the study.The patients were divided into 2 groups by computer-assisted randomization:30 for the PENG block and the other 30 for the Intrathecal fentanyl group. Data were obtained from anesthesia records and followed up with a patient follow-up form. Intraoperative hemodynamic data, motor and sensory block maximal level, motor and sensory block regression time, side effects, and surgical satisfaction were recorded.Pinprick test, straight leg raise test, and Bromage scale were used.Results The demographic details of the patients were similar. Pain scores (NRS) at positions, postoperative 8th, 12th, and 24th, were lower in the PENG group. The rates of ephedrine, positional pain, and nausea/vomiting were found to be statistically significantly higher in the intrathecal fentanyl group than in the PENG group.At 30 minutes after PENG block, it was observed that all 28 patients in the group were able to perform a 15° straight leg raising and knee flexion movement without any discomfort or pain.Conclusions In hip fracture patients who will undergo PFN surgery, it has been observed that hemodynamics is preserved in the intraoperative period, additional analgesic consumption is reduced in the postoperative period, pain control is provided more easily, and early mobilization and early discharge are allowed with the application of PENG block added to low-dose local anesthetic.