Anaesthetists, Dr John Barry and Dr Sean McManus discuss the role of the anaesthetist in the care of patients with fractured neck of femurs, including the challenges of pain management in the older patient, particularly those with cognitive impairment. Elderly patients with hip fracture are at risk of being undertreated for pain which can contribute to longer lengths of stay and poorer functional outcomes. John and Sean discuss the advantages and disadvantages of different modes of analgesia that are available and the clinical significance of fascia and femoral nerve blocks.