Pericapsular nerve group block combined with lateral femoral cutaneous nerve block versus fascia iliaca compartment block for hip surgery: a systematic review, meta-analysis, and trial sequential analysis.

BACKGROUND

The combination of the pericapsular nerve group (PENG) and lateral femoral cutaneous nerve (LFCN) blocks has been proposed as a motor-sparing alternative to the fascia iliaca compartment block (FICB) for analgesia after hip surgery. However, previous reviews were limited by insufficient data to draw definitive conclusions regarding this specific combination.

METHODS

The authors conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing PENG plus LFCN versus FICB. They searched PubMed, Scopus, Embase, Cochrane CENTRAL, and Web of Science. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool. Data were synthesized using a random-effects model in accordance with PRISMA.

RESULTS

Six RCTs (442 patients) were included in the analysis. PENG + LFCN significantly reduced resting pain scores at 6 hours (mean difference [MD] -0.72; 95% confidence interval [CI] -1.28 to -0.16; P = 0.012) and at 24 hours (MD -0.91; 95% CI -1.59 to -0.23; P = 0.009) compared with FICB. The combined block also demonstrated superior preservation of motor function with higher quadriceps muscle strength grades at 6 hours (MD 1.10; P < 0.001) and 24 hours (MD 0.89; P = 0.012), and a lower incidence of muscle weakness at 6 hours (risk ratio 0.10; P = 0.005). The time to ambulation was significantly shorter. There was no significant difference in opioid consumption or in the incidence of nausea and vomiting.

CONCLUSIONS

PENG plus LFCN provides superior analgesia and motor preservation compared with FICB, facilitating early ambulation and optimizing functional recovery.