The postoperative analgesic efficacy of three peripheral nerve blocks in hip fracture surgery: a systematic review and meta-analysis of randomised trials

INTRODUCTION: Anaesthesia for hip fracture surgery is often supplemented with a peripheral nerve block (PNB) to reduce postoperative pain. Common PNBs include fascia-iliaca compartment block (FICB) and femoral nerve block (FNB). Since the introduction of the pericapsular nerve group (PENG) block, debate continues as to which technique provides superior analgesia. This review aimed to compare the postoperative analgesic efficacy of three PNBs when administered perioperatively to adult hip fracture patients. METHODS: CINAHL, Cochrane CENTRAL, Embase, Medline, Web of Science and Google Scholar were searched in April 2025. Statistical analysis was performed using a random-effects model. RESULTS: 19 randomised trials (1059 patients) were included. Pain scores between PENG and FICB at 6, 12 and 24 h were not significantly different. Compared to FNB, PENG significantly lowered pain scores at 6 h (P = 0.004). Opioid consumption in the 24 h postoperative period was significantly lower in PENG than FICB (P = 0.02), but not in FNB. No outcome reached the minimal clinically important difference. Evidence was graded very low to moderate. CONCLUSION: There is insufficient evidence to state superiority of PENG over FICB or FNB when used perioperatively in patients undergoing hip fracture repair. No included studies reported time to mobilisation, highlighting a significant evidence gap in existing primary research. Further high-quality, sufficiently powered randomised trials are still needed.