The role of the pericapsular nerve group block in early mobilisation and functional recovery after total hip arthroplasty: A systematic review and meta-analysis

Background and Aims: This systematic review and meta-analysis evaluated the motor-sparing pericapsular nerve group (PENG) block’s effect on early mobilisation and functional recovery outcomes following total hip arthroplasty (THA). Methods: We searched MEDLINE, Web of Science, EMBASE, the Cochrane Library, ClinicalTrials.gov, and International Clinical Trials Registry Platform (ICTRP) up to 31 May 2025 for randomised controlled trials (RCTs) comparing PENG block with non-PENG analgesic strategies in adult THA patients. The primary outcome was time to first mobilisation. Secondary outcomes included Quality of Recovery (QoR) scores, quadriceps strength, hip range of motion, dynamic pain scores, patient satisfaction, and length of hospital stay. Risk of bias was assessed using the RoB 2 tool. Evidence certainty was evaluated using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) framework. Meta-analyses were conducted using random-effects models. Results: Twenty-six RCTs involving 2208 patients were included. PENG block reduced time to first mobilisation [mean difference (MD), -2.68 h; 95% confidence interval (CI) -3.84 to -1.53; P < 0.001] and improved quadriceps strength on post-operative day (POD) 1 [standardised mean difference (SMD), 0.35; 95% CI 0.05 to 0.64; P = 0.02], hip range of motion (MD 12.69°; 95% CI 1.05 to 24.33; P = 0.03), patient satisfaction (SMD 0.48; 95% CI 0.11 to 0.85; P = 0.01), and length of hospital stay (MD, -0.41 days; 95% CI -0.67 to -0.15; P = 0.002). No significant effects were found for QoR scores, quadriceps strength on POD 2, or dynamic pain scores. No major block-related complications were reported. Conclusion: In this synthesis of RCTs through May 2025, compared with non-PENG analgesic strategies, the PENG block was associated with earlier time to first mobilisation after THA and improvements in some early recovery outcomes, including quadriceps strength on POD 1, hip range of motion, patient satisfaction, and length of stay. Further large, standardised trials are needed to validate these findings and define their clinical significance.