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Background & objective: Femoral bone fracture may cause considerable amount of pain. Many techniques have been described to ease pain in this group of patients. However, regional block technique remains underutilised and not regularly done. We evaluated the efficacy of ultrasound-guided (USG) 3-in-1 femoral nerve block versus the landmark-based single shot fascia iliaca compartment block as an analgesia method prior to positioning for spinal anesthesia in patients going for femur fracture surgery. Methodology: A total of 60 patients aged between 18 to 65 years old from ASA class I to III were included. They were divided into two groups by using computer assisted randomization. Group I received single shot landmark based-fascia iliaca compartment block whereas Group II received USG femoral 3-in-1 block. Ropivacaine 0.375% was used in both groups with a total volume depends on patient body weight. The pain score at rest, upon movement and at interval of 5-10 min after block performed recorded using Visual Analog Score. Results: Ultrasound guided femoral 3-in-1 block provides faster pain reduction at least 5-min post block (1.7 ± 0.75, P = 0.011) and significant relief at 20-min post block (1.33 ± 1.16, P = 0.026). Less intravenous fentanyl was required for rescue analgesia in Group II (10.83 ± 29.13, P = 0.018). Conclusion: Femoral 3-in-1 block provides much faster relief of pain in femoral bone fracture but both blocks are equally effective if given enough time to work out. Both are equally effective and appeared to be safe. [ABSTRACT FROM AUTHOR]