Meta-analysis shows PENG+LFCN block reduces pain and weakness versus FICB in hip surgery ERAS pathways

This systematic review and meta-analysis examined regional analgesic strategies for patients undergoing hip surgery within Enhanced Recovery After Surgery pathways. The authors compared pericapsular nerve group block combined with lateral femoral cutaneous nerve block against fascia iliaca compartment block across sixteen included studies. The scope focused on secondary outcomes including pain, muscle function, and recovery metrics rather than a single primary outcome.

Patients receiving the PENG+LFCN intervention demonstrated significantly lower resting pain with a mean difference of -0.54 and a p-value less than 0.00001. Dynamic pain scores were also significantly lower with a mean difference of -0.98 and a p-value less than 0.00001. The incidence of postoperative muscle weakness was lower with an odds ratio of 0.10 and a p-value of 0.0001. Quadriceps muscle strength showed better preservation in the PENG+LFCN group, though specific effect sizes were not reported for this metric.

Recovery metrics favored the PENG+LFCN approach with a mean difference of -9.22 hours for time to first ambulation and a p-value less than 0.0001. Length of stay was reduced by a mean difference of -0.75 days with a p-value less than 0.00001. Morphine consumption decreased by a mean difference of -24.22 mg with a p-value of 0.001. PCA pump activations were lower with a mean difference of -2.46 and a p-value less than 0.00001. Safety data and adverse events were not reported in the source material.

The authors conclude that PENG+LFCN may be a more favorable regional analgesic strategy than FICB for hip surgery within ERAS pathways. Practice relevance is tempered by the absence of reported certainty notes and the lack of specific adverse event data. Clinicians should interpret these pooled results with caution given the observational nature of some included evidence and the lack of reported causality notes.