Fifty-two patients with femoral intertrochanteric fractures were randomized to receive either a pericapsular nerve group (PENG) block combined with spinal anesthesia (n=26) or spinal anesthesia alone (n=26). Outcomes of interest included the mean arterial pressure (MAP) and heart rate (HR) during various perioperative stages, and Visual Analog Scale (VAS) scores for pain at rest and during passive straight leg elevation at multiple postoperative intervals. Outcomes were assessed up to seven days after surgery. Overall, the results of the study revealed that the PENG block combined with spinal anesthesia group had significantly lower MAP and HR during lateral positioning and lower VAS scores postoperatively compared to the spinal anesthesia alone group. The main findings suggest that PENG block combined with spinal anesthesia can effectively reduce perioperative pain and stabilize vital signs in elderly patients with femoral intertrochanteric fractures.