Pericapsular nerve group block for total hip arthroplasty: A systematic review

ObjectivePericapsular nerve group block spares the main trunk of the femoral nerve, and its use has rapidly expanded from hip fracture surgery to total hip arthroplasty, where preservation of quadriceps function is paramount for early rehabilitation and ambulation. This systematic review investigated the analgesic and motor-sparing benefits of pericapsular nerve group block for total hip arthroplasty.MethodsThis systematic review included randomized trials evaluating pericapsular nerve group block in adult patients undergoing total hip arthroplasty. Databases, including MEDLINE, EMBASE, CINAHL, and Google Scholar, were searched (inception through May 2026). Only randomized trials published in English, with prospective registration and without discrepancies between the registered and reported protocols, were retained for analysis.ResultsAcross 10 randomized trials, from an analgesic standpoint, pericapsular nerve group block was found to be noninferior to intrathecal morphine (100 µg) and superior to infrainguinal fascia iliaca block. Pericapsular nerve group block provided similar analgesia and breakthrough opioid consumption compared with suprainguinal fascia iliaca block, anterior quadratus lumborum block, and L4 erector spinae plane block; however, it may improve motor strength during the initial postoperative period. Combined lateral quadratus lumborum block-periarticular local anesthetic infiltration and combined pericapsular nerve group block-periarticular local anesthetic infiltration-lateral femoral cutaneous nerve block provided similar pain at rest and functional outcomes, although lateral quadratus lumborum block-periarticular local anesthetic infiltration achieved lower pain with movement and reduced opioid requirements. Compared with pericapsular nerve group block, periarticular local anesthetic infiltration resulted in lower dynamic pain (first 6 h) and static pain (first 48 h), and adding pericapsular nerve group block to a robust periarticular local anesthetic infiltration regimen provided minimal incremental benefit.ConclusionPericapsular nerve group block provided an equianalgesic, motor-sparing alternative to suprainguinal fascia iliaca block, anterior quadratus lumborum block, and lumbar erector spinae plane block for total hip arthroplasty. However, intrathecal morphine may provide comparable analgesia to pericapsular nerve group block. Furthermore, a robust periarticular local anesthetic infiltration regimen may outperform pericapsular nerve group block. Consequently, future large-scale trials are required to elucidate the benefits of pericapsular nerve group block compared with intrathecal morphine (for inpatient total hip arthroplasty) and periarticular local anesthetic infiltration (for inpatient and outpatient total hip arthroplasty).INPLASY registration numberINPLASY202670024.