Pericapsular nerve group (PENG) block with lateral femoral cutaneous nerve (LFCN) block versus fascia iliaca compartment block (FICB) for hip surgery: A systematic review and meta-analysis

Background: Effective analgesia that preserves motor function is essential for early mobilization after hip surgery. Although fascia iliaca compartment block (FICB) is recommended for total hip arthroplasty, the comparative efficacy of combined pericapsular nerve group and lateral femoral cutaneous nerve blocks (PENG + LFCN) remains uncertain. Methods: Databases including Embase, Web of Science, PubMed, Cochrane Central, and China National Knowledge Infrastructure were searched up to December 8, 2024. Statistical analyses were performed using Review Manager (RevMan) (computer program, version 5.4, The Cochrane Collaboration, 2020). Results: Seven randomized controlled trials involving 572 participants were included. Compared with FICB, PENG + LFCN significantly reduced static pain at 12 hours (mean difference [MD] = −0.19; 95% confidence interval [CI], −0.28 to −0.11; P < .0001) and dynamic pain at 6 hours (MD = −0.87; 95% CI, −1.64 to −0.10; P = .03) and 48 hours (MD = −0.26; 95% CI, −0.49 to −0.02; P = .03). It also lowered quadriceps weakness (odds ratio = 0.09; 95% CI, 0.04–0.21; P < .00001), improved limb strength (MD = 1.03; 95% CI, 0.05–2.01; P = .04), reduced patient-controlled intravenous analgesia frequency (MD = −1.64; 95% CI, −3.13 to −0.15; P = .03), and shortened mobilization time (MD = −9.04; 95% CI, −14.28 to −3.80; P = .0007). Conclusion: PENG + LFCN may provide superior early analgesia and better preserve lower-limb motor function than FICB after hip surgery. However, the evidence is limited by few trials, small sample sizes, and substantial heterogeneity. Larger, adequately powered trials are warranted.