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Pericapsular Nerve Group Block Combined With Lateral Femoral Cutaneous Nerve Block Versus Fascia Iliaca Compartment
Abdullah M Alharran1, Mahnd Alaenezi2, Fahad AlAbduljader2
1College of Medicine & Medical Sciences, Arabian Gulf University, Manama, BHR.
Abstract:
Postoperative pain after hip surgery remains a critical challenge, and traditional regional blocks like the fascia iliaca compartment block (FICB) frequently cause quadriceps motor weakness. The pericapsular nerve group (PENG) block, combined with a lateral femoral cutaneous nerve (LFCN) block, is a novel motor-sparing alternative. This systematic review and meta-analysis compares the efficacy and safety of PENG + LFCN versus FICB in patients undergoing hip surgery. A systematic search was conducted across five databases (PubMed, Scopus, CENTRAL, Web of Science [WoS], and Google Scholar) up to December 2025. Eligible randomized controlled trials (RCTs) were assessed for methodological quality using the RoB-2 tool. Primary outcomes were pain scores and quadriceps motor strength (QMS). Secondary outcomes included rescue analgesia, time to first ambulation, and complications. Standardized mean differences (SMDs) and risk ratios (RRs) were pooled with 95% confidence interval (CI). Five RCTs involving 382 patients were included. The PENG + LFCN block significantly improved QMS compared to FICB at 6 hours (SMD: 1.04, 95% CI [0.63, 1.45]; p < 0.001), 12 hours (SMD: 2.02, 95% CI [0.64, 3.40]; p < 0.001), and 24 hours (SMD: 0.90, 95% CI [0.12, 1.68]; p = 0.02). Furthermore, the combined block significantly decreased pain scores at rest at 12 hours (SMD: -0.88, 95% CI [-1.62, -0.15]; p = 0.02), 24 hours (SMD: -0.80, 95% CI [-1.41, -0.19]; p = 0.01), and 48 hours (SMD: -1.04, 95% CI [-1.66, -0.42]; p < 0.001). The PENG + LFCN block was associated with a significant reduction in rescue analgesia requirements (RR: 0.44, 95% CI [0.22, 0.86]; p = 0.02) and time to first ambulation (MD: -4.08 hours, 95% CI [-7.37, -0.80]; p = 0.01). The PENG + LFCN block was associated with a significant motor-sparing effect and reduced pain scores at rest compared to FICB, resulting in faster ambulation and lower requirements for rescue analgesia. Accordingly, this combined block may represent a better alternative for optimal postoperative recovery in hip surgery, but more trials remain warranted.
