Supra Inguinal Fascia Iliac Versus PENG Block for Post-Operative Pain Management of Hip Arthroplasty: A Narrative Review

Effective post-operative pain management following hip arthroplasty is critical to improving recovery, reducing opioid consumption, enhancing mobility, and reducing the risk of complications for patients. Multimodal anesthesia strategies, including the supra inguinal fascia iliac block (SIFIB) and the periarticular nerve group (PENG) block have become the new point of focus as opposed to traditional methods previously used. This narrative review compares the SIFIB and the PENG block in their efficacy to treat post-operative pain management. Mechanism of action, safety, patient outcomes, and clinical applications are compared between the two blocks for evaluation. Clinical studies have indicated that both blocks reduce post-operative pain and reduce opioid use. In contrast, SIFIB has shown to be more preferred in more complex procedures such as total hip arthroplasty, which requires extensive nerve coverage despite its longer onset time. The SIFIB has been shown to carry a higher risk of impairing motor function, making the PENG highly preferred in patients where quick mobility improvement is prioritized. The PENG block also showed slightly higher efficacy in reducing pain associated with post-operative passive limb movements, and a slight decrease in opioid consumption in comparison to SIFIB in the early post-operative time frame. Although the PENG shows more benefits in the early stages of post-operative recovery, the SIFIB shows similar outcomes to PENG over longer durations of recovery. Future studies can aid in establishing a framework for tailoring block selection to individual patient needs to optimize clinical outcomes.