Meta-Analysis of PENG+LFCN versus FICB on ERAS-Related Outcomes: Postoperative Pain, Motor Function and Recovery in Hip Surgery

Clinical Snapshot

Key Findings

• P Value: p < 0.00001 for primary pain outcomes

• Effect Size: Dynamic VAS pain reduction MD = -0.98, muscle weakness OR = 0.10

• Primary Outcome: Resting VAS pain scores significantly lower with PENG+LFCN (MD = -0.54)

• Nnt Or Sensitivity: Time to ambulation reduced by 9.22 hours, length of stay reduced by 0.75 days

• Confidence Interval: Not reported in abstract

Clinical Application

Requires expertise in ultrasound-guided regional anaesthesia techniques, may need additional training for PENG+LFCN combination Relevant to Australian orthopaedic and anaesthetic practice; ERAS pathways increasingly adopted in Australian hospitals; technique availability depends on local anaesthetic expertise Hip surgery patients in ERAS pathways, particularly those requiring optimal motor function preservation

Abstract

OBJECTIVE: To compare pericapsular nerve group block combined with lateral femoral cutaneous nerve block (PENG+LFCN) with fascia iliaca compartment block (FICB) for postoperative analgesia and functional recovery after hip surgery within Enhanced Recovery After Surgery (ERAS) pathways. METHODS: PubMed, Embase, the Cochrane Library, CNKI, Wanfang Data, and CQVIP were searched through January 2026. Comparative studies of PENG+LFCN versus FICB in hip surgery were included. Data were pooled using a random-effects model, with assessment of bias, heterogeneity, and publication bias. RESULTS: Sixteen studies were included. The PENG+LFCN group had significantly lower resting VAS (MD = -0.54; p < 0.00001) and dynamic VAS (MD = -0.98; p < 0.00001) scores. It also showed a lower incidence of postoperative muscle weakness (OR = 0.10; p = 0.0001), better preservation of quadriceps muscle strength, shorter time to first ambulation (MD = -9.22 h; p < 0.0001), and reduced length of stay (MD = -0.75 days; p < 0.00001). Additionally, morphine consumption (MD = -24.22 mg; p = 0.001) and PCA pump activations (MD = -2.46; p < 0.00001) were lower in the PENG+LFCN group. CONCLUSION: PENG+LFCN may be a more favorable regional analgesic strategy than FICB for hip surgery within ERAS pathways. PROTOCOL REGISTRATION: This systematic review and meta-analysis was registered at PROSPERO https://www.crd.york.ac.uk/PROSPERO/view/CRD420261295309.

References

1. 1.Li, J., Zhang, X., Zu, C., Chen, Q., Lian, L., Zhu, Z., Hou, S., Sun, H., Zhang, Y., & Li, J. (2026). Meta-Analysis of PENG+LFCN versus FICB on ERAS-Related Outcomes: Postoperative Pain, Motor Function and Recovery in Hip Surgery. Journal of Investigative Surgery, 1-12. https://doi.org/10.1080/08941939.2026.2663595