Background: Fracture of the femur is a common orthopaedic problem following trauma in patients of all ages. This study was undertaken to compare the effectiveness of intravenous (IV) fentanyl with femoral nerve block (FNB) in positioning the patients for combined spinal epidural anesthesia (CSE). Methods: 100 patients between the ages 25 to 75 years, of ASA grade I, II and III, scheduled for elective surgeries of femur fracture were evaluated in 2 groups. Group-1 (n=50) received femoral nerve block with 15ml of 1.5% lignocaine and Group-2 (n=50) patients received one dose of IV fentanyl 1g/kg. Assessment of pain was carried out using visual analog scale (VAS). This was rated before, during and after the procedure of positioning for spinal/combined spinal epidural anesthesia (CSE). Vital parameters were tabulated. Results: VAS scores were noted at 0, 2, 5, 10, 15 minutes and at the time of positioning. The average VAS scores at 15 minutes in Group-1 was 1.47 and 3.82 in patients in Group-2. Time taken for CSE was significantly less in Group-1 (13.02 minutes) as compared to Group-2 (19.66 minutes). Patient satisfaction scores were significantly higher in Group-1 (45/50) 1.49 as compared to non Group-2 (10/50) 0.34. Quality of patient positioning was better in Group-1 (2.78) as compared to Group-2 (1.38). Conclusions: This study concludes that FNB is highly effective in giving good pain relief for positioning for regional anaesthetic procedures improving performance time and offers higher acceptance among patients with femoral fractures as compared to IV fentanyl.