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Background and Aims Currently three types of regional nerve blocks are in use to provide analgesia to patients with hip fractures; the Fascia-Iliaca Compartment Block (FICB), Femoral Nerve Block (FNB) and Pericapsular Nerve Group Block (PENG). It is unclear which of these provides the best analgesia and the lowest number of complications. This systematic review aims to evaluate the literature concerning the efficacy and safety of pre-operatively placed PENG block compared to FICB and FNB for hip fractures.

Methods The PRISMA statement guidelines were used and a systematic search of MEDLINE (via Ovid), Embase, Web of Science and Google Scholar was performed until April 8th 2024.

Results 118 studies were identified, and after review 18 studies were included. Significant heterogeneity in outcome measures was present. Patients receiving PENG block reported better pain score outcomes (12 out of 17 studies), better patient satisfaction (5 out of 7 studies), better movement or quadriceps strength (4 out of 5 studies), less additional opioid use (5 out of 10 studies) and improved EOSP (4 out of 7 studies). None of the studies found FNB or FICB be favourable on these outcomes. No significant differences were found between blocks for (serious) adverse events.

Conclusions PENG block is a promising technique to provide analgesia to patients with a hip fracture. However, there is significant heterogeneity in both endpoints used and in outcomes of the various studies that compared PENG with FM or FICB blocks. Larger randomized controlled trials with patient-centred outcomes are required to definitively establish which nerve block is most effective.