Comparison between pericapsular nerve group block and fascia iliaca compartment block for perioperative pain control in hip surgeries: A meta-analysis from randomized controlled trials

Figures & data

Figure 1. (PRISMA) flow chart representing the search and selection process.

Table 1. Baseline characteristics of the included trials.

No.	Study ID	Country	Number (PENG/ FICB)	Surgery	Anesthesia	Time of intervention	LA Dose (PENG/FICB)	Postoperative analgesia	Outcomes
1	Shankar 2020 [23]	India	60 (30/30)	Hip fracture	SA	Preoperative	25 ml of 0.25% Ropivacaine	Tramadol 1 mg/kg IV as rescue analgesic	Pain scores (VAS), Opioid consumption, Quality of patient positioning.
2	Aliste 2021 [24]	Canada	40 (20/20)	Primary total hip arthroplasty	SA	Postoperative in PACU.	100 mg adrenalized levobupivacaine with epinephrine 5 µg/mL	PCA morphine infusion, paracetamol (1 gm/6 hr) and ketoprofen (100 mg/8 hr).	Pain scores (NRS) at rest and movement, Opioid consumption, Incidence of quadriceps motor block, Block-related adverse events, Length of hospital stay.
3	Jadon 2021 [25]	India	66 (33/33)	Hip fracture surgeries	SA	Preoperative	25 ml mixture of 0.25% bupivacaine and 8 mg dexamethasone	Paracetamol 1 gm IV every 8 h and 50 mg tramadol as rescue analgesia	Pain scores (NRS) at rest and movement, Opioid consumption, Quality of patient positioning.
4	Kulkarni 2021 [26]	India	60 (30/30)	Hip fracture surgeries	SA	Preoperative	20 mL of 0.25% bupivacaine	Not reported	Pain scores (NRS) during positioning, Quality of positioning, Patient acceptance
5	Natrajan 2021 [22]	India	24 (12/12)	Dynamic hip screw fixation or hemiarthroplasty	SA	Preoperative	20 mL of 0.5% ropivacaine	Paracetamol 1 gm, IV as rescue analgesic.	Pain scores (NRS), Time to first rescue analgesic, PONV.
6	Senthil 2021 [27]	India	40 (20/20)	Dynamic hip screw fixation and proximal femur nailing	SA	At the end of surgery	30 mL 0.25% Levobupivacaine and 4 mg dexamethasone	PCA fentanyl infusion	Pain scores (NRS, VAS) at rest and movement, Opioid consumption, Quadriceps femoris muscle strength.
7	Choi 2022 [28]	Korea	54 (27/27)	Unilateral total hip arthroplasty	GA	After induction of anesthesia	20 mL of ropivacaine 0.2% with epinephrine 1:200,000	PCA fentanyl infusion, celecoxib 200 mg orally and paracetamol 1 gm IV every 12 h.	Pain scores (NRS) at rest and movement, Opioid consumption, Quadriceps femoris muscle strength, Length of hospital stay, PONV, Patient satisfaction.
8	Hua 2022 [29]	China	48 (24/24)	Hip arthroplasty	SA	Preoperative	20 ml ropivacaine 0.4%	PCA sufentanil infusion and oxycodone 1 mg IV as rescue analgesia	Pain scores (VAS) at rest and movement, Opioid consumption, Block-related adverse events. Patient satisfaction.
9	Krishnamurty 2022 [30]	India	80 (40/40)	Hip fracture surgeries	SA	Preoperative	25 ml Bupivacaine 0.25%	Tramadol as rescue analgesic	Pain scores (VAS), Opioid consumption, Quality of patient positioning.
10	Mosaffa 2022 [31]	Iran	52 (30/22)	Hip fracture surgeries	SA	Preoperative	3 mL/kg (maximum 40 mL) ropivacaine 0.5%	PCA morphine infusion.	Pain scores (VAS), Opioid consumption, Time to first rescue analgesic.

Figure 2. Risk of bias summary according to the Cochrane risk of bias assessment tool; risk of bias domains includes mainly (selection bias, performance bias, detection bias, attrition bias, and reporting bias).

Figure 3. Risk of bias graph for included studies.

Figure 4. Forest plot for pain scores during patient positioning for spinal anesthesia.

Figure 5. Forest plot for static pain scores measured at different time points postoperatively.

Figure 6. Forest plot for dynamic pain scores measured at different time points postoperatively.

Figure 7. Forest plot for accumulated opioid consumption (equivalent morphine dose by mg) within 24 hours postoperatively.

Figure 8. Forest plot for time to first rescue analgesia request postoperatively.

Figure 9. Forest plot for quality of positioning during spinal anesthesia.

Figure 10. Forest plot for incidence of patient dissatisfaction.

Figure 11. Forest plot for incidence of PONV.

Figure 12. Forest plot for length of hospital stay in days.

Shankar K, Srinivasan R, Ashwin AB, et al. Comparative study of ultrasound guided PENG [Pericapsular Nerve Group] block and FIB [Fascia Iliaca Block] for positioning and postoperative analgesia prior to spinal anaesthesia for Hip surgeries: prospective randomised comparative clinical study. Indian J Anesth Analg. 2020;7:798–803.

 Google Scholar

Aliste J, Layera S, Bravo D, et al. Randomized comparison between pericapsular nerve group (PENG) block and suprainguinal fascia iliaca block for total Hip arthroplasty. Reg Anesth Pain Med. 2021;46(10):874–878.

 PubMed Web of Science ®Google Scholar

Jadon A, Mohsin K, Sahoo RK, et al. Comparison of supra-inguinal fascia iliaca versus pericapsular nerve block for ease of positioning during spinal anaesthesia: a randomised double-blinded trial. Indian J Anesth. 2021;65:572–578.

 PubMed Web of Science ®Google Scholar

Kulkarni PB, Ghodki PS, Prabhu AV. Pericapsular Nerve Group Block (PENG) and Fascia Iliaca Compartment Block (FICB) for Positioning Patients with Hip Fractures for Spinal Anaesthesia: a Comparative Study between The Two Blocks. Arch Anesthesiol Critical Care. 2022;8:123–128.

 Google Scholar

Natrajan P, Bhat RR, Remadevi R, et al. Comparative study to evaluate the effect of ultrasound-guided pericapsular nerve group block versus fascia iliaca compartment block on the postoperative analgesic effect in patients undergoing surgeries for Hip fracture under spinal anesthesia. Anesth Essays Res. 2021;15(3):285–289.

 PubMedGoogle Scholar

Senthil KS, Kumar P, Ramakrishnan L. Comparison of pericapsular nerve group block versus fascia iliaca compartment block as postoperative pain management in Hip fracture surgeries. Anesth Essays Res. 2021;15(4):352–356.

 PubMedGoogle Scholar

Choi YS, Park KK, Lee B, et al. Pericapsular Nerve Group (PENG) Block versus Supra-Inguinal Fascia Iliaca Compartment Block for Total Hip Arthroplasty: a Randomized Clinical Trial. J Pers Med. 2022;12:408.

 PubMed Web of Science ®Google Scholar

Hua H, Xu Y, Jiang M, et al. Evaluation of Pericapsular Nerve Group (PENG) Block for Analgesic Effect in Elderly Patients with Femoral Neck Fracture Undergoing Hip Arthroplasty. J Healthc Eng. 2022;2022:1–7.

 Web of Science ®Google Scholar

Krishnamurty P, Girish MN, Dileep PK. Ultrasound guided Fascia Iliaca Block versus Pericapsular Nerve Group for Postoperative Analgesia Prior to Spinal Anaesthesia for Hip Surgeries. Int J Health Sci (Qassim). 2022;6:5084–5092.

 Google Scholar

Mosaffa F, Taheri M, Rasi AM, et al. Comparison of pericapsular nerve group (PENG) block with fascia iliaca compartment block (FICB) for pain control in Hip fractures: a double-blind prospective randomized controlled clinical trial. Orthop Traumatol Surg Res. 2022;108(1):103135.

 PubMed Web of Science ®Google Scholar