Pericapsular Nerve Group Block Versus Fascia Iliaca Compartment Block for Hip Arthroplasty: An Updated Meta-Analysis of Randomized Controlled Trials With Trial Sequential Analysis

Purpose: Regional anesthesia techniques are crucial for optimizing pain management after hip arthroplasty. The pericapsular nerve group (PENG) block represents a novel approach targeting specific neural structures for hip joint innervation. Objective: To evaluate the efficacy of PENG block compared to suprainguinal fascia iliaca compartment block (S-FICB) in adult patients undergoing hip arthroplasty, focusing on postoperative opioid consumption, pain scores, and mobilization time. Methods: We conducted a systematic review following PRISMA guidelines, searching PubMed and Scopus databases through October 2025. Only randomized controlled trials comparing PENG block with S-FICB were included. Risk of bias was assessed using the revised Cochrane tool. Meta-analysis employed random effects modeling, with evidence strength evaluated using GRADE methodology. Results: Five randomized controlled trials (824 patients) were included. PENG block significantly reduced 24-h opioid consumption compared to S-FICB (MD −3.85 mg, 95% CI −6.61 to −1.09, p = 0.006, I2 = 87%), improved pain scores (MD −0.74, 95% CI −1.28 to −0.19, p = 0.008, I2 = 74%), and shortened time to mobilization (MD −6.94 h, 95% CI −8.96 to −4.93, p < 0.00001, I2 = 0%). Trial sequential analysis demonstrated robust evidence for mobilization time, with qualified support for analgesic outcomes due to incomplete information size and heterogeneity. Evidence certainty was high for mobilization time and moderate for opioid consumption and pain scores. Conclusions: PENG block provides statistically significant reductions in opioid consumption and pain scores, with robust and clinically meaningful earlier mobilization compared to S-FICB in patients undergoing hip arthroplasty. These findings support incorporating PENG block into multimodal enhanced recovery pathways, though heterogeneity in analgesic outcomes warrants cautious interpretation.