Ultrasound-guided pericapsular nerve group block (PENG) and fascia iliac compartment block (FICB) are alternative methods of pain relief during lower limb orthopedic surgery. However, the efficacy and safety of PENG compared with FICB have not been fully established.We comprehensively searched randomized controlled trials (RCTs) about comparing PENG with FICB for patients with lower limb orthopedic surgery through the databases of Pubmed, Embase, Cochrane Library, CNKI and Wanfang database with no limitation of language from their inception date to December 2022. Two reviewers were independently involved in the process of data extraction. The main outcome measures were pain scores in resting state and exercise state at different time points. Secondary outcome indexes were the first analgesia time, intraoperative remfentanil consumption, fentanyl consumption at 24 hours after surgery, morphine consumption at 24 hours after surgery, satisfaction score for postoperative analgesia, quadriceps muscle strength at 6 and 24 hours after surgery, incidence of adverse reactions such as nausea and vomiting. The Rev Man 5.3 software was used for meta-analysis of the data.Finally, a total of 8 RCTs with 210 patients in PENG group and 201 patients in FICB group were included in this meta-analysis. Pooled analysis indicated that there were no significant differences between the two groups in resting state and exercise state pain scores before nerve block and postoperative incidence of nausea and vomiting (P>0.05). Compared with FICB, pain scores at 10nim, 20min and 30min after nerve block, at 6h, 12h, 24h and 48h after surgery at resting state and exercise state, intraoperative remifentanil consumption, total sufentanil consumption and morphine consumption at 24h after surgery were significantly reduced in PENG group (P<0.05). In addition, compared with FICB group, the first postoperative analgesia time, postoperative analgesia satisfaction score, and quadriceps muscle strength 6h and 24h after surgery were significantly improved in PENG group (P<0.05) .Existing clinical evidence shows that compared with FICB , ultrasus-guided PENG has better analgesic effect in lower limb orthopedic surgery, patients need less intraoperative and postoperative opioid analgesic drugs, the duration of analgesia is longer, the effect on postoperative lower limb muscle strength of patients is less, and the occurrence of adverse reactions of nausea and vomiting is not increased.

Lei Ni, Huang Qingqing, Liu Jingzhen, Li Qin, Dai Xuemei, Gong Gu. Ultrasound-guided pericapsular nerve group block versus fascia iliac compartment block for pain control in lower limb orthopedic surgery: A meta-analysis from randomized controlled trials. Frontiers in Medical Science Research (2023) Vol. 5, Issue 8: 14-25. https://doi.org/10.25236/FMSR.2023.050803.

[1] Xu H, Li H, Zuo Y, et al. A multicenter study of the analgesic effects of epidural chloroprocaine after lower limb orthopedic surgery. J Clin Anesth. 2016; 35: 313-320. 

[2] Aytolign HA, Mersha AT, Ferede YA. Analgesic efficacy of posterior and anterior psoas compartment block: Lumbar plexus versus three -in-one nerve block after lower limb orthopedic surgery under spinal anesthesia: A prospective cohort study. Ann Med Surg (Lond). 2021; 73: 103160. 

[3] Singh RK, Chaturvedi JP, Agrawal HS, et al. Lower limb orthopedic surgery in geriatric patients under paravertebral blocks: A prospective feasibility study. Med J Armed Forces India. 2016; 72(3): 215-9. 

[4] Li XD, Han C, Yu WL. Is Femoral Nerve Block Superior to Fascia Iliac Block in Hip Surgery? Meta-Analysis of Randomized Controlled Trials. Biomed Res Int. 2022; 2022: 4840501. 

[5] Min H, Ouyang Y, Chen G. Anterior cruciate ligament reconstruction with the use of adductor canal block can achieve similar pain control as femoral nerve block. Knee Surg Sports Traumatol Arthrosc. 2020; 28(8): 2675-2686. 

[6] Kim DH, Beathe JC, Lin Y, et al. Addition of Infiltration Between the Popliteal Artery and the Capsule of the Posterior Knee and Adductor Canal Block to Periarticular Injection Enhances Postoperative Pain Control in Total Knee Arthroplasty: A Randomized Controlled Trial. Anesth Analg. 2019; 129(2): 526-535. 

[7] Girón-Arango L, Peng PWH, Chin KJ, et al. Pericapsular Nerve Group (PENG) Block for Hip Fracture. Reg Anesth Pain Med. 2018; 43(8): 859-863. 

[8] 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. 

[9] 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. 

[10] Kong M, Tang Y, Tong F, et al. The analgesic efficacy of pericapsular nerve group block in patients with intertrochanteric femur fracture: A randomized controlled trial. PLoS One. 2022; 17(10): e0275793. 

[11] Zhang Chen, Wang Xiao, Sun Xianqin. Comparison of ultrasound-guided pericapsular nerve block and iliofascial space block for postoperative analgesia in patients with hip fracture [J]. Journal of Medicine Forum, 2002, 43(19): 36-39. 

[12] 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: 7452716. 

[13] 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(3):408.

[14] Mosaffa F, Taheri M, Manafi Rasi A, 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. 

[15] Zhang Yao, Liu Songhua, Wang Huimin, et al. Analgesic effect of pericapsular nerve block of hip joint in senile patients with PFNA fixation [J]. Chinese Journal of Medical Medicine, 2002, 24(06): 823-827, 832. 

[16] Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009; 6(7): e1000097. 

[17] Cumpston M, Li T, Page MJ, et al. Updated guidance for trusted systematic reviews: a new edition of the Cochrane Handbook for Systematic Reviews of Interventions. Cochrane Database Syst Rev. 2019; 10: ED000142. 

[18] Wan X, Wang W, Liu J, et al. Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Med Res Methodol. 2014; 14: 135. 

[19] Luo D, Wan X, Liu J, et al. Optimally estimating the sample mean from the sample size, median, mid-range, and/or mid-quartile range. Stat Methods Med Res. 2018; 27(6): 1785-1805. 

[20] Jin Z, Durrands T, Li R, et al. Pectoral block versus paravertebral block: a systematic review, meta-analysis and trial sequential analysis. Reg Anesth Pain Med. 2020; 45(9): 727-732. 

[21] Dalens B, Vanneuville G, Tanguy A. Comparison of the fascia iliaca compartment block with the 3-in-1 block in children. Anesth Analg. 1989; 69(6): 705-13. 

[22] Capdevila X, Biboulet P, Bouregba M, et al. Comparison of the three-in-one and fascia iliaca compartment blocks in adults: clinical and radiographic analysis. Anesth Analg. 1998; 86(5): 1039-44. 

[23] Kim YS, Cha JR, Lee YS, et al. Sugammadex affects emergence agitation in children undergoing strabismus surgery. J Int Med Res. 2018; 46(9): 3861-3872. 

[24] Fahey A, Cripps E, Ng A, et al. Pericapsular nerve group block for hip fracture is feasible, safe and effective in the emergency department: A prospective observational comparative cohort study. Emerg Med Australas. 2022; 34(6): 884-891. 

[25] Girón-Arango L, Peng PWH, Chin KJ, et al. Pericapsular Nerve Group (PENG) Block for Hip Fracture. Reg Anesth Pain Med. 2018; 43(8): 859-863.