Pericapsular Nerve Group (PENG) Block Versus Suprainguinal Fascia Iliaca Block (SI-FICB) for Perioperative Analgesia...

The optimal regional anesthetic technique to facilitate spinal anesthesia and early mobilization in hip fracture surgery remains uncertain. The suprainguinal fascia iliaca block (SI-FICB) aims to enhance cranial spread within the fascia iliaca plane, whereas the pericapsular nerve group (PENG) block selectively targets articular branches to the anterior hip capsule with a motor-sparing intent. Randomized trials comparing the two techniques have produced heterogeneous results. We conducted a systematic review and meta-analysis of randomized controlled trials directly comparing PENG with SI-FICB in adults (≥60 years) undergoing operative management of acute hip fracture under neuraxial anesthesia. The primary outcome was pain within 60 minutes of block administration, with secondary outcomes including pain at rest, pain on movement, time to first rescue analgesia, number of rescue doses, and 24 h opioid consumption. Continuous data were synthesized using random-effects modelling (REML) with Hartung-Knapp-Sidik-Jonkman adjustment, and medians with IQRs or ranges were transformed to mean±SD using the Wan and Luo methods. Risk of bias was assessed using RoB 2 and certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE). Eleven perioperative RCTs (n=1,260; PENG: 630; SI-FICB: 630) were included. PENG reduced pain at rest within 60 minutes (mean difference {MD} -0.51, 95% CI: -0.74 to -0.28; T=4.97; I²=81%) and pain on movement (MD: -0.52, 95% CI: -0.71 to -0.34; T=6.49; I²=0%). No significant differences were observed for time to first rescue (MD -0.83 h, 95% CI: -1.92 to 0.26; T=1.75; I²=95%), number of rescue doses (MD: -0.08, 95% CI: -0.46 to 0.29; T=0.71; I²=37%), or 24 h opioid consumption (MD: -15.59 mg oral morphine equivalent {OME}, 95% CI: -43.00 to 11.83; T=1.58; I²=100%). The "T" value represents the test statistic produced by the Hartung-Knapp-Sidik-Jonkman (HKSJ) adjustment in the random-effects model. PENG provides superior immediate analgesia for spinal positioning and early perioperative pain control compared with SI-FICB, though heterogeneity in secondary outcomes highlights the need for further standardized RCTs to clarify optimal dosing, timing, and functional endpoints.