BACKGROUND This study aimed to compare femoral obturator nerve block (FONB) with fascia iliaca compartment block (FICB) in the management of acute preoperative pain in elderly patients with hip fracture. MATERIAL AND METHODS Patients ≥65 years (n=154) diagnosed with hip fracture who had surgery within 48 hours of hospital admission included two groups who received ultrasound-guided nerve block, the FONB group (n=77), and the FICB group (n=77). The visual analog scale (VAS) score for pain, requirement for analgesic drugs, nursing care requirements after hospitalization, post-operative complications, and rehabilitation were compared between the FONB and FICB patient groups. RESULTS The VAS scores after both nerve block procedures were significantly reduced compared with those before both nerve block procedures (P<0.05), but there were no differences on the second day after nerve block. The VAS scores at rest and on exercise in the FONB group were significantly lower than those in the FICB group at 30 min and one day after nerve block (P<0.05). The requirement for postoperative analgesic drugs in the FONB group was significantly lower than that in the FICB group (P=0.048). The incidence of nausea and vertigo in the FICB group were significantly higher than in the FONB group (P=0.031 and P=0.034, respectively). Patients in the FONB group experienced significantly improved quality of postoperative function (P=0.029). CONCLUSIONS Both FONB and FICB provided pain control for elderly patients with hip fracture. However, compared with FICB, FONB resulted in significantly improved analgesia with a reduced requirement for analgesic drugs.