Comparison between peng block and femoral nerve block in anesthesia for hip surgeries: an integrative literature review
DOI:
https://doi.org/10.37497/JMRReview.v5i00.109Keywords:
Hip Fracture, PENG Block, Femoral Nerve Block, Regional Anesthesia, Postoperative Analgesia, Early MobilizationAbstract
Background: Hip fractures are highly prevalent among the elderly and are associated with high morbidity and mortality as well as functional impairment, requiring early surgical intervention and effective pain management. Regional anesthesia techniques, such as femoral nerve block, are widely used; however, they have limitations related to motor block, which has led to the development of alternatives such as pericapsular nerve group (PENG) block.
Aim: To conduct a systematic review comparing the outcomes of PENG blocks and femoral nerve blocks for analgesia in hip surgery.
Method: A systematic review was conducted in the PubMed database using the following search strategy: (peng[title] AND block[title]) AND (femoral[title] AND nerve[title] AND block[title]). Clinical trials and observational studies published in the last 10 years were included. After screening, 9 studies were selected for analysis.
Results: Studies have shown that both blocks are effective in pain control, with a reduction in opioid use. The PENG block showed better preservation of motor function and benefits for early mobilization, while the femoral nerve block demonstrated consistent analgesic efficacy but was associated with a higher risk of muscle weakness. In some scenarios, combining the PENG block with other blocks yielded superior results.
Conclusion: The PENG block is an effective and safe option for pain management in hip surgery, offering the advantage of preserving motor function and potentially having a positive impact on functional recovery. However, the choice of technique should be tailored to the individual, taking into account clinical characteristics and the need to combine it with other analgesic strategies.
References
BHANDARI, Mohit; SWIONTKOWSKI, Marc. Management of Acute Hip Fracture. New England Journal of Medicine, v. 377, n. 21, p. 2053–2062, 23 nov. 2017.
CARDOSO, Fabricio A.; FORTUNA-COSTA, Anneliese; GARCIA, Luis V. Analgesic effect of lateral femoral cutaneous nerve block added to the pericapsular nerve group (PENG) block in primary total hip arthroplasty: a randomized clinical trial. Minerva Anestesiologica, v. 91, n. 1–2, p. 26–35, 2025.
GARGANO, Francesca et al. A randomized clinical trial comparing different combination of peripheral nerve blocks for intraoperative analgesia in patients on antithrombotic drugs undergoing hip fracture surgery: pericapsular nerve group (PENG) block versus femoral and obturator nerve block. Minerva Anestesiologica, v. 91, n. 6, p. 524–532, jun. 2025.
GURBUZ, Hande; COLAK, Tuncay. Evaluation of inguinal sonoanatomy regarding pericapsular nerve group (PENG) block in children: the relation of femoral artery, femoral nerve, lateral femoral cutaneous nerve and iliopsoas notch. BMC anesthesiology, v. 25, n. 1, p. 144, 31 mar. 2025.
KIM, Jeayoun et al. Recurrence-free survival after curative resection of non-small cell lung cancer between inhalational gas anesthesia and propofol-based total intravenous anesthesia: a multicenter, randomized, clinical trial (GAS TIVA trial): protocol description. Perioperative Medicine, v. 13, p. 79, 23 jul. 2024.
LEE, Kun-Han et al. Regional anaesthesia modalities for primary total hip arthroplasty: a systematic review and component network meta-analysis. British Journal of Anaesthesia, v. 135, n. 2, p. 469–482, ago. 2025.
LEWIS, Sharon R. et al. Surgical interventions for treating extracapsular hip fractures in older adults: a network meta‐analysis. Cochrane Database of Systematic Reviews, n. 2, 2022.
LIANG, Ludan et al. Comparison between pericapsular nerve group (PENG) block with lateral femoral cutaneous nerve block and supra-inguinal fascia iliaca compartment block (S-FICB) for total hip arthroplasty: a randomized controlled trial. Journal of Anesthesia, v. 37, n. 4, p. 503–510, ago. 2023.
LIN, D.-Yin et al. Pericapsular nerve group (PENG) block provides improved short-term analgesia compared with the femoral nerve block in hip fracture surgery: a single-center double-blinded randomized comparative trial. Regional Anesthesia and Pain Medicine, v. 46, n. 5, p. 398–403, maio 2021.
LIU, Yiju Teresa; TOVAR HIRASHIMA, Eva; YADAV, Kabir. Peripheral Nerve Blocks for Hip Fractures. JAMA, v. 333, n. 23, p. 2106–2107, 17 jun. 2025.
NEUMAN, Mark D. et al. Spinal Anesthesia or General Anesthesia for Hip Surgery in Older Adults. New England Journal of Medicine, v. 385, n. 22, p. 2025–2035, 24 nov. 2021.
SCHROEDER, Jeremy D.; TURNER, Sean P.; BUCK, Emily. Hip Fractures: Diagnosis and Management. American Family Physician, v. 106, n. 6, p. 675–683, dez. 2022.
SCHWENK, Eric S.; MCCARTNEY, Colin Jl. General anesthesia is an acceptable choice for hip fracture surgery. Regional Anesthesia and Pain Medicine, v. 48, n. 8, p. 428–429, ago. 2023.
ŞEKER, Dinçer Firat et al. The effect of adding lateral femoral cutaneous nerve block to pericapsular nerve group (PENG) block in hip surgery on postoperative morphine consumption: A randomized controlled trial. Medicine, v. 104, n. 38, p. e44588, 19 set. 2025.
WU, Han et al. The effect of pericapsular nerve group (PENG) block on postoperative analgesia in elderly patients who underwent proximal femoral nail anti-rotation surgery: a prospective, randomized-controlled trial. BMC anesthesiology, v. 24, n. 1, p. 421, 21 nov. 2024.
YOO, Seung-Hee et al. Efficacy of Supplemental Ultrasound-Guided Pericapsular Nerve Group (PENG) Block Combined with Lateral Femoral Cutaneous Nerve Block in Patients Receiving Local Infiltration Analgesia after Hip Fracture Surgery: A Prospective Randomized Controlled Trial. Medicina, v. 60, n. 2, p. 315, 12 fev. 2024.
