Lumbar Erector Spinae Plane Block Versus PENG Block for Hip Fracture Surgery

The purpose of this clinical trial is to compare two different nerve block techniques-the Pericapsular Nerve Group (PENG) block and the Lumbar Erector Spinae Plane Block (L-ESPB)-for managing pain after hip fracture surgery in elderly patients. Hip fractures are common in older adults and often cause significant pain. Managing this pain effectively helps patients recover faster and move around sooner after surgery. Traditional pain relief options include nerve blocks and strong pain medications (opioids). However, opioids can cause unwanted side effects like nausea and drowsiness, while some traditional nerve blocks can weaken the leg muscles, making early walking difficult. Nerve blocks inject a local anesthetic (numbing medication) around specific nerves or within muscle layers to temporarily block pain signals: 1. PENG Block: Targets the specific sensory nerves supplying the front of the hip joint while minimizing leg muscle weakness. 2. Lumbar ESPB: Injects numbing medication near the lower spine to block pain signals coming from the hip region. Participants in this study will include adults aged 60 and older undergoing hip surgery for a femoral neck fracture under spinal anesthesia. Participants will be randomly assigned (like flipping a coin) to receive either the PENG block or the Lumbar ESPB before their surgery. Both blocks are performed under ultrasound guidance to ensure precise medication placement. Researchers will compare: * Pain levels at rest and during movement over the first 48 hours after surgery. * The total amount of additional pain medication (opioids) required. * Leg muscle (quadriceps) strength after surgery. * Any side effects or complications, as well as the overall length of hospital stay. The findings from this study will help doctors determine which nerve block provides better pain relief while preserving leg strength, aiding in safer and faster recovery for elderly patients after hip surgery.

Inclusion Criteria: 1. Age 60 years or older. 2. Unilateral fracture neck of femur scheduled for hip surgery (hemiarthroplasty or total hip arthroplasty) under spinal anesthesia (with or without light sedation). 3. American Society of Anesthesiologists (ASA) physical status II-III. 4. Ability to understand and use Numeric Rating Scale (NRS) pain scoring and to provide informed consent (or availability of a legally authorized representative according to local regulations). Exclusion Criteria: 1. Patient refusal to participate. 2. Coagulopathy (platelet count \< 100,000/µL, INR \> 1.4) or ongoing therapeutic anticoagulation that precludes deep peripheral or neuraxial blocks per current guidelines. 3. Infection at the injection site, systemic sepsis, or hemodynamic instability. 4. Pre-existing significant neurological deficit in the involved lower limb, advanced peripheral neuropathy, or cognitive impairment precluding reliable pain assessment. 5. Known allergy or hypersensitivity to amide local anesthetics or study medications. 6. Severe chronic opioid use (defined as \> 30 mg oral morphine equivalent daily for \> 3 months). 7. Body Mass Index (BMI) \> 35 kg/m² if considered to significantly hinder ultrasound visualization, at investigator discretion. 8. Prior hip surgery on the same side or severe anatomical hip deformity affecting block performance.