Please confirm that an ethics committee approval has been applied for or granted: Not relevant

Background and Aims Elderly patients with hip fractures coming for surgical fixation pose unique challenges and require a judicial fine balance. Motor weakness imposed by traditional nerve blocks (FIB and FNB). Although these conventional nerve blocks provide good pain relief they impose risks of more motor weakness and that induces delay in rehabilitation and postoperative falls.

Methods We thus imposed newer motor-sparing blocks (PENG, SIFI, and LFCN blocks). Over two years, we conducted an audit in which time we saw shifting away more toward newer motor sparing blocks.

Results We analysed the data of 118 patients who underwent hip fracture surgery and received GA and or SA with traditional and/or newer motor-sparing nerve blocks. Patients who received any form of nerve blocks had a longer time to rescue analgesia and lesser requirement for both on-demand as well as regular opioids. SPatients who received nerve blocks cooperated better with physiotherapy once they gained motor power, but this resulted in a bit higher limb weakness and postoperative falls, especially in the traditional block group.

Conclusions Overall the use of nerve blocks has improved the immediate pain as well as reduced the opioid requirements. The use of adjuvants in nerve blocks and the promotion of motor-sparing nerve blocks in ED and theatre will possibly improve further outcomes.