Femoral nerve block (FNB) is an accepted mode of analgesia for lower limb procedures but has a documented complication rate. This study compared femoral nerve and fascia iliaca regional anesthesia for total knee arthroplasty (TKA), using fentanyl consumption as the primary outcome measure. Ninety-eight primary unilateral TKA patients were blinded and randomized into fascia iliaca block (FIB) (n = 51) or FNB (n = 47) groups. No significant differences were found in analgesia use (fentanyl and tramadol) at 12 and 36 hours in pain, nausea and range of motion between the groups. There was one case of paresthesia in the femoral nerve in the FNB group. Fascia iliaca block is as effective as FNB as part of a multimodal anesthetic regimen for TKA.