Fast-track surgical care (a coordinated peri-operative approach aimed at reducing surgical stress and facilitating post-operative recovery) is a desired goal for patients operated for hip fracture. This pathology usually occurs in a very vulnerable patient population - elderly with multiple co-morbidities. They are well known to have an increased risk of re-admission, mortality and prolonged hospitalisation. Pre-operative optimisation is challenging as surgery cannot be postponed for much time without increasing the risks. Anesthetic management may influence the outcome and there is a lot of pressure and expectations from regional anesthesia to improve it. the bright side of regional anesthesia consists in the ability to decrease the thromboembolic risk, to reduce pain and to reduce the metabolic endocrine response to pain and surgery. the dark side is represented by the risk of motor block, the possible alteration of urinary bladder function and risks specific to the procedures like spinal hematoma formation, nerve damage or systemic toxicity of local anesthetics. Peripheral nerve blocks as a single technique or in association, lumbar plexus block, neuraxial procedures and local anesthetic infiltrations were all used and studied for these patients. It is clear now that regional anesthesia can provide good pain relief and reduce morphine consumption, infection rates, hospital length of stay and rates of cardiovascular and pulmonary complications. However the demonstrated reduction in mortality is regarded as nonsignificant. Until more data is available anesthesia should be tailored to individual patient requirements and the anaesthetists’ experience.