Femoral and hip fracture surgery is associated with substantial perioperative pain and frequent opioid requirements. This study compared the opioid-sparing effects of anatomical fascia iliaca compartment block (FICB) performed before surgical incision with those of the same block performed at wound closure in adults undergoing femoral or hip fracture repair under general anaesthesia. In this prospective, single-centre, randomised comparative study, 68 adults classified as American Society of Anesthesiologists physical status I–III were allocated equally to preoperative FICB or postoperative FICB. Each participant received 40 mL of 0.25% plain bupivacaine by the anatomical landmark technique, together with a standardised general anaesthetic and multimodal analgesic regimen. Postoperative pain was assessed using the numerical rating scale, and the time to first request for additional analgesia and cumulative morphine consumption during the first 24 and 48 postoperative hours were recorded. Preoperative FICB significantly prolonged the mean time to first analgesic request compared with postoperative FICB (264.44±37.37 versus 116.47±36.00 minutes; p<0.001). Median morphine consumption was also lower after preoperative FICB at 24 hours (54.9 [33.6–84.6] versus 80.4 [57.6–96.0] mg; p<0.001) and 48 hours (53.32 [40.8–64.8] versus 81.6 [63.0–91.2] mg; p<0.001). Scheduled ketorolac and paracetamol consumption did not differ significantly between groups. In this study population, preoperative anatomical FICB was associated with delayed rescue-analgesic requirement and reduced early postoperative morphine consumption compared with postoperative FICB. Preoperative FICB may therefore be a useful component of multimodal analgesia for selected adults undergoing femoral or hip fracture surgery.