Pericapsular Nerve Group (PENG) Block versus Fascia Iliaca Compartment Block (FICB) for Analgesia in Adult Patients with Hip Fracture
Date First Published:
August 27, 2026
Last Updated:
August 27, 2026
Report by:
Abdelwahab Taher Zahra and Karim Ahmed Elsherbini, Final-year Medical Students (Horus University, Egypt)
Search checked by:
Prof. Khaled El Bahrawy, Professor of Anaesthesia and Intensive Care, Faculty of Medicine, Mansoura University, Egypt
Three-Part Question:
In adult patients with hip fracture does ultrasound-guided pericapsular nerve group (PENG) block compared with ultrasound-guided fascia iliaca compartment block (FICB) provide superior analgesia and reduce opioid requirements?
Clinical Scenario:
An adult patient presents to the emergency department with a painful hip fracture requiring analgesia before definitive management. You consider performing an ultrasound-guided regional nerve block and wonder whether the pericapsular nerve group (PENG) block provides superior analgesia compared with the fascia iliaca compartment block (FICB).
Search Strategy:
A literature search was conducted in PubMed on 28 July 2026 using the following search strategy:
Search Details:
("pericapsular nerve group block" OR "PENG block") AND ("fascia iliaca block" OR "FICB") AND ("hip fracture" OR "proximal femur fracture")
Filters applied:
Published within the last 10 years
English language
Humans
Adults (≥19 years)
Filters applied:
Published within the last 10 years
English language
Humans
Adults (≥19 years)
Outcome:
The literature search identified 13 records in PubMed. Following title and abstract screening, studies that did not directly compare PENG block with FICB in adult patients with hip fracture, involved different populations (e.g. hip arthroplasty), evaluated different interventions, or were review articles were excluded. Five studies met the predefined PICO eligibility criteria and were included in the final appraisal, comprising four randomised controlled trials and one retrospective comparative study (Table 1). The reference lists of the included studies were also screened; however, no additional eligible studies were identified. As the literature search was limited to PubMed, it remains possible that additional relevant studies indexed in other databases were not identified.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Comparing the pericapsular nerve group block and fascia iliaca block for acute pain management in patients with hip fracture: a randomised clinical trial Di Pietro S, Maffeis R, Jannelli E, Mascia B, Resta F, De Silvestri A, Musella V, Centurioni CE, Regeni E, Grassi FA, Locatelli A, Perlini S 2025 Italy | 64 adults with acute proximal hip fracture and moderate-to-severe pain (32 PENG, 32 FICB). | Single-centre, randomized clinical trial conducted in an academic emergency department. Intervention: Ultrasound-guided PENG block using 20 mL 0.375% levobupivacaine + 4 mg dexamethasone. Comparator: Ultrasound-guided infrainguinal fascia iliaca compartment block (FICB) using 30 mL 0.25% levobupivacaine + 4 mg dexamethasone. |
Primary: Percentage Sum of Pain Intensity Difference (%SPID) | PENG produced greater %SPID than FICB (62.7% vs 38.0%, p<0.001); more patients achieved both ≥33% SPID (28/32 vs 19/32, p=0.022) and ≥50% SPID (24/32 vs 7/32, p<0.001); no significant difference in rescue opioid use or adverse events. | Single-Centre study (planned multicentre recruitment not achieved), limited generalisability, 1-hour follow-up only, and no assessment of long-term/postoperative outcomes. |
| over the first 60 min. | |||||
| Secondary: ≥33% and ≥50% SPID, rescue opioid use, adverse events | |||||
| Analgesic efficacy of Pericapsular Nerve Group (PENG) block compared with Fascia Iliaca Block (FIB) in the elderly patient with fracture of the proximal femur in the emergency room. A randomised controlled trial. Marrone F, Graziano G, Paventi S, Tomei M, Gucciardino P, Bosco M 2023 Italy | 60 patients aged ≥65 years with traumatic proximal femoral fracture presenting to the ER (30 PENG, 30 FICB randomised; 30 PENG, 28 FICB analysed) | Exploratory, double-blind, randomized controlled trial conducted in the emergency department. Intervention: Ultrasound-guided PENG block using 20 mL of 0.375% ropivacaine. Comparator: Ultrasound-guided infrainguinal fascia iliaca compartment block (FICB) using 40 mL of 0.2% ropivacaine. |
Primary: analgesic success (Numeric Rating Scale (NRS) | Analgesic success was similar between groups (PENG 16/30 [53.3%] vs FICB 15/28 [53.6%]; P = 0.98). PENG was not superior to FICB for acute pain management. | Single-Centre study; modest sample size; primary outcome assessed at a single 30-min time point, which may not capture changes in analgesic effect over time. |
| ≤4 at 30 min after block). | |||||
| Secondary: pain at rest at 30 min, duration of analgesia (time to first analgesic request), rescue analgesia for block failure, and block-related complications. | |||||
| Supra-inguinal fascia iliaca block versus peri-capsular nerve group (PNEG) block for pain management in patients with hip fracture: A double-blind randomised comparative trial. Huang KT, Tsai HI, Kao SC 2024 Taiwan | 100 patients with hip fracture awaiting surgery; 91 completed the study (46 S-FICB, 45 PENG). | Prospective, double-blind, randomised comparative trial. Intervention PENG block: 20 mL of 0.35% ropivacaine. Comparator Suprainguinal fascia iliaca block (S-FICB): 30 mL of 0.35% ropivacaine. |
Primary: NRS pain scores at rest and during passive movement 30 min after nerve block. | No significant difference between PENG and S-FICB in pain scores at 30 min at rest (P = 0.151) or during passive movement (P = 0.99). However, PENG produced earlier pain reduction at rest (20 min vs. 30 min) and required less time to perform than S-FICB (3.1 vs. 4.6 min; P < 0.001). | Modest sample size; primary outcome assessed only at 30 min, which may not fully capture differences in analgesic duration. |
| Secondary: pain scores at rest and during movement at 10 and 20 min, pain during positioning for spinal anaesthesia, time required to perform the nerve block and spinal anaesthesia, and quality of positioning for spinal anaesthesia. | |||||
| Comparison of pericapsular nerve group block and supra-inguinal fascia iliaca compartment block for preoperative analgesia in elderly patients with hip fracture: A prospective, randomized controlled study. Liao H, Wan Z, Su J, Han D, Lin W, Yu M, Sun G, Song F, Zhou J 2026 China | 64 consecutive patients aged ≥65 years with hip fracture, NRS ≥4, American Society of Anesthesiologists (ASA) I–III undergoing surgery (PENG n=32; S-FICB n=32). | Single-Centre, observer-blind, prospective, randomised controlled study. Intervention Ultrasound-guided PENG block using 30 mL of 0.33% ropivacaine. Comparator Ultrasound-guided suprainguinal fascia iliaca compartment block (S-FICB) using 30 mL of 0.33% ropivacaine. |
Primary: Block success rate. | PENG achieved a significantly higher block success rate than SFICB (90.62% vs. 68.75%; P < 0.05). Pre-spinal NRS pain scores were significantly lower in the PENG group (P < 0.05). PENG also required significantly shorter nerve block performance time and spinal anaesthesia time (P < 0.05). No significant differences were observed in postoperative pain relief, morphine consumption during the first 2 postoperative days, vital signs, adverse reactions, or PACU stay between the groups. | Single-centre study with a relatively small sample size, limiting generalisability. |
| Secondary: NRS pain scores before spinal anaesthesia, nerve block performance time, spinal anaesthesia time, postoperative pain relief, morphine consumption during the first 2 postoperative days, vital signs, adverse reactions, and Post-Anaesthesia Care Unit (PACU) | |||||
| stay. | |||||
| Comparison of the perioperative efficacy of pericapsular nerve group (PENG) block and the suprainguinal fascia iliaca compartment block (S-FICB) in patients undergoing hip fracture surgery: Spinal positioning, medication usage, and patient satisfaction. Gedikbaş M, Genç A. 2025 Turkey | 115 patients with intertrochanteric femoral fractures undergoing proximal femoral nailing under spinal anaesthesia (PENG n=59; S-FICB n=56). | Single-centre retrospective comparative study. Intervention Ultrasound-guided PENG block before spinal anaesthesia. Comparator Ultrasound-guided suprainguinal fascia iliaca compartment block (S-FICB) before spinal anaesthesia. |
Primary: Pain intensity (NRS) before spinal positioning and at 1, 3, 6, 9, 12, 15, 18, 21, and 24 h postoperatively. Secondary: Time to first systemic analgesic consumption, total opioid consumption, motor block duration, patient satisfaction, ease of spinal positioning, postoperative nausea/vomiting, and length of hospital stay. | PENG significantly reduced pre-spinal positioning pain (2.88±1.38 vs. 3.48±1.11; p=0.01), movement-related pain at the 6th (p=0.01) and 12th (p=0.04) postoperative hours, prolonged time to first opioid use (15.67±3.45 vs. 11.71±2.24 h; p=0.03), reduced total postoperative opioid consumption (44.07±51.77 vs. 58.04±47.46 mg tramadol hydrochloride; p=0.04), shortened motor block duration (2.36±1.16 vs. 3.16±1.50 h; p=0.002), improved patient satisfaction (7.80±1.24 vs. 7.27±1.46; p=0.04), and reduced postoperative nausea (p=0.03) and vomiting (p=0.04). No significant difference was observed in hospital stay or surgical duration. | Retrospective design; single-centre study; pain assessed using only the NRS; fracture subtypes were not analysed separately. |
Author Commentary:
Our results are summarized in Table 1.
The five included studies comprised four prospective randomised clinical trials and one retrospective comparative study. All were single-centre studies, with sample sizes ranging from 60 to 115 participants. Three clinical trials were double-blind or observer-blind (Marrone et al., Huang et al., and Liao et al.), whereas the retrospective comparative study (Gedikbaş & Genç, 2025) was based on routinely collected clinical data and is therefore more susceptible to selection bias and residual confounding.
Among studies comparing PENG block with infrainguinal FICB, findings regarding early analgesic efficacy were inconsistent. Di Pietro et al. (2025) demonstrated significantly greater early pain reduction with PENG block over the first 60 minutes, whereas Marrone et al. (2023) found no significant difference in analgesic success between the two techniques at 30 minutes. These differences may reflect variations in outcome definitions, local anaesthetic protocols, and assessment time points rather than true differences in clinical efficacy.
Among studies comparing PENG block with suprainguinal FICB, Huang et al. (2024) found no significant difference in pain scores at rest or during passive movement 30 minutes after nerve block administration. However, the PENG block required a smaller volume of local anaesthetic and was completed more quickly.Liao et al. (2026) reported a higher block success rate with PENG block, lower pain scores before spinal anaesthesia, and shorter block-performance and spinal anaesthesia times, while postoperative pain scores, opioid consumption, adverse events, and recovery outcomes were comparable between groups.
The retrospective comparative study by Gedikbaş & Genç (2025) reported lower pain intensity before spinal positioning, reduced postoperative opioid consumption, shorter motor block duration, higher patient satisfaction, and less postoperative nausea and vomiting with PENG block. However, these findings should be interpreted cautiously because retrospective observational studies cannot fully account for confounding and selection bias.
Interpretation of the available evidence is limited by clinical heterogeneity. Included studies differed in the FICB technique used (infrainguinal versus suprainguinal), local anaesthetic volume, outcome definitions, and timing of pain assessment, limiting direct comparison across studies. Although several studies suggest potential advantages of PENG block for selected perioperative outcomes, the current evidence remains insufficient to establish clear superiority over FICB.
The five included studies comprised four prospective randomised clinical trials and one retrospective comparative study. All were single-centre studies, with sample sizes ranging from 60 to 115 participants. Three clinical trials were double-blind or observer-blind (Marrone et al., Huang et al., and Liao et al.), whereas the retrospective comparative study (Gedikbaş & Genç, 2025) was based on routinely collected clinical data and is therefore more susceptible to selection bias and residual confounding.
Among studies comparing PENG block with infrainguinal FICB, findings regarding early analgesic efficacy were inconsistent. Di Pietro et al. (2025) demonstrated significantly greater early pain reduction with PENG block over the first 60 minutes, whereas Marrone et al. (2023) found no significant difference in analgesic success between the two techniques at 30 minutes. These differences may reflect variations in outcome definitions, local anaesthetic protocols, and assessment time points rather than true differences in clinical efficacy.
Among studies comparing PENG block with suprainguinal FICB, Huang et al. (2024) found no significant difference in pain scores at rest or during passive movement 30 minutes after nerve block administration. However, the PENG block required a smaller volume of local anaesthetic and was completed more quickly.Liao et al. (2026) reported a higher block success rate with PENG block, lower pain scores before spinal anaesthesia, and shorter block-performance and spinal anaesthesia times, while postoperative pain scores, opioid consumption, adverse events, and recovery outcomes were comparable between groups.
The retrospective comparative study by Gedikbaş & Genç (2025) reported lower pain intensity before spinal positioning, reduced postoperative opioid consumption, shorter motor block duration, higher patient satisfaction, and less postoperative nausea and vomiting with PENG block. However, these findings should be interpreted cautiously because retrospective observational studies cannot fully account for confounding and selection bias.
Interpretation of the available evidence is limited by clinical heterogeneity. Included studies differed in the FICB technique used (infrainguinal versus suprainguinal), local anaesthetic volume, outcome definitions, and timing of pain assessment, limiting direct comparison across studies. Although several studies suggest potential advantages of PENG block for selected perioperative outcomes, the current evidence remains insufficient to establish clear superiority over FICB.
Bottom Line:
Current evidence suggests that both ultrasound-guided PENG block and fascia iliaca compartment block provide effective analgesia for adult patients with hip fracture. PENG block may offer modest advantages in selected perioperative outcomes, including improved pain control before spinal anaesthesia, higher block success, shorter block-performance time, and reduced postoperative opioid requirements in some studies. However, analgesic outcomes were not consistently superior across all studies, and differences in comparator technique (infrainguinal versus suprainguinal FICB), study methodology, and outcome assessment limit the certainty of these findings. At present, the available evidence is insufficient to recommend PENG block as unequivocally superior to FICB, and further adequately powered multicentre randomised controlled trials using standardised techniques and outcome measures are required.
Level of Evidence:
Level 2: Studies considered were neither 1 or 3
References:
- Di Pietro S, Maffeis R, Jannelli E, Mascia B, Resta F, De Silvestri A, Musella V, Centurioni CE, Regeni E, Grassi FA, Locatelli A, Perlini S. Comparing the pericapsular nerve group block and fascia iliaca block for acute pain management in patients with hip fracture: a randomised clinical trial
- Marrone F, Graziano G, Paventi S, Tomei M, Gucciardino P, Bosco M. Analgesic efficacy of Pericapsular Nerve Group (PENG) block compared with Fascia Iliaca Block (FIB) in the elderly patient with fracture of the proximal femur in the emergency room. A randomised controlled trial.
- Huang KT, Tsai HI, Kao SC. Supra-inguinal fascia iliaca block versus peri-capsular nerve group (PNEG) block for pain management in patients with hip fracture: A double-blind randomised comparative trial.
- Liao H, Wan Z, Su J, Han D, Lin W, Yu M, Sun G, Song F, Zhou J. Comparison of pericapsular nerve group block and supra-inguinal fascia iliaca compartment block for preoperative analgesia in elderly patients with hip fracture: A prospective, randomized controlled study.
- Gedikbaş M, Genç A.. Comparison of the perioperative efficacy of pericapsular nerve group (PENG) block and the suprainguinal fascia iliaca compartment block (S-FICB) in patients undergoing hip fracture surgery: Spinal positioning, medication usage, and patient satisfaction.