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Analgesic and Functional Outcomes of the Pericapsular Nerve Group Block Versus the Quadratus Lumborum Block After Hip
I-Ning Hsu1, Yu-Pin Huang2, Yu-Lin Tsai3,4
1Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital Linkou Center, Taoyuan, Taiwan.
Objective:
Pericapsular nerve group (PENG) block and quadratus lumborum block (QLB) are regional anesthesia techniques for postoperative analgesia after hip surgery. No meta-analysis has directly compared these techniques. This systematic review and meta-analysis compared analgesic, opioid-sparing, functional, and safety outcomes between PENG block and QLB.
Methods:
PubMed, Embase, Cochrane Library, and Web of Science were searched for relevant articles until April 15, 2026. Head-to-head randomized controlled trials (RCTs) comparing PENG block with QLB were included. The primary outcome was postoperative pain, and the secondary outcomes were opioid consumption, functional recovery, and adverse events. Pain outcomes were pooled as standardized mean differences and converted to mean differences on a 0-10 scale for comparison with the 1-point minimal clinically important difference.
Results:
Seven RCTs (536 patients) were included. No significant differences were observed between PENG block and QLB across eight pain assessment windows (four time points, at rest and during movement). After pain data conversion, six of eight pooled estimates fell within ±1 point, indicating no clinically important difference. Scores for the remaining two windows (early pain during movement and 24-h resting pain) were inconclusive because of high heterogeneity and very low certainty evidence. Notably, 24-h opioid consumption and nausea and vomiting incidence were similar between PENG block and QLB. Narrative synthesis suggested a preliminary, transient motor-sparing advantage with PENG in some RCTs, requiring confirmation in adequately powered trials.
Conclusion:
PENG block and QLB provide comparable analgesia, opioid-sparing benefits, and short-term safety after hip surgery. However, the evidence for early pain during movement and 24-h resting pain exhibited high heterogeneity and very low certainty of evidence and should be interpreted cautiously. A possible early motor-sparing benefit of PENG block is an exploratory signal and warrants further confirmation in adequately powered trials using objective functional endpoints.
