Systematic Review of Hip Fractures and Regional Anesthesia: Efficacy of the Main Blocks and Comparison for a Multidisciplinary and Effective Approach for Patients in the Hospital Setting of Anesthesiology and Resuscitation
Abstract
1. Introduction
2. Methodology
2.1. Design and Analysis
2.2. Regulated Search and Selection Process
2.3. Inclusion/Exclusion Criteria
2.4. Risk of Bias
- 1.
- Bias arising from the randomization process,
- 2.
- Bias due to deviations from intended interventions,
- 3.
- Bias due to missing outcome data,
- 4.
- Bias in the measurement of the outcome,
- 5.
- Bias in the selection of the reported result.
2.5. Certainty of Evidence Assessment (GRADE)
- Risk of bias (based on the Cochrane RoB 2.0 tool),
- Inconsistency (heterogeneity across study results),
- Indirectness (applicability of the evidence to the target population and setting),
- Imprecision (precision of estimates, including confidence intervals and sample size considerations),
- Publication bias (suspected or detected through available data).
2.6. Forest Plots
2.6.1. Forest Plot—24-Hour Opioid Consumption
2.6.2. Forest Plot—Quadriceps Strength Preservation:
2.7. Study Selection and Data Presentation
2.8. Effect Measures and Data Synthesis
2.9. Aditional Methodological Information
2.10. Data Availability
- Template data collection forms: Not applicable; data extraction was performed manually based on predefined eligibility criteria.
- Data extracted from included studies: Available upon reasonable request from the corresponding author.
- Data used for all analyses: Available upon reasonable request.
- Analytic code: Not applicable, as no meta-analyses or statistical code were generated.
- Other materials: No additional materials beyond those included in the manuscript and supplementary files are available.
3. Results
4. Discussion
Limitations of the Study
5. Conclusions
- 1.
- The reviewed studies suggest that PENG block offers significant advantages over femoral and fascia iliaca blocks in terms of effective analgesia, motor preservation, and reduction of opioid consumption.
- If the primary goal is early mobility preservation, PENG block is superior to FNB and FICB.
- For more extensive analgesia, the combination of PENG+LFCN or PENG+sciatic block may be ideal in certain surgical scenarios.
- FICB remains a valid option, especially in surgeries with a wide lateral approach.
- FNB should be reserved for patients where motor weakness is not a concern, given its impact on the quadriceps
- 2.
- PENG block is associated with less muscle weakness and better postoperative pain control compared to fascia iliaca block, without significantly increasing the risk of complications.
- 3.
- The literature suggests that PENG is the block of choice for intracapsular fractures, while for extracapsular fractures, FICB may be more appropriate, or PENG may be complemented with additional blocks such as LFCN or sciatic block to improve the analgesic coverage provided to the patient. The choice should be individualized ac-cording to the type of fracture, the surgical approach, and the patient’s functional needs, always taking into consideration the motor limitations caused by exposed blocks, which have a lesser impact when PENG block is used.
- 4.
- Regarding the comparison of PENG with other less common blocks in clinical practice, there is little or no consensus, but some publications conclude that QLB may offer better postoperative analgesia in terms of lower opioid consumption, while PENG block may be superior in preserving motor function, facilitating early mobilization. The choice between these blocks should be based on the patient’s specific analgesia and motor preservation needs.
- 5.
- Individualization of treatment based on the type of fracture, surgical approach, and rehabilitation goals remains key in selecting the optimal analgesic strategy.
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Databases | Search Process | Results Obtained |
---|---|---|
Pubmed | Title, Abstract: (Hip Arthroplasty OR Hip Surgery OR Hip Replacement OR Hip Fracture) AND (Pericapsular Nerve Group OR PENG block OR Fascia Iliaca Block OR Femoral Nerve Block OR Lumbar Plexus Block OR Quadratus Lumborum Block) AND (Regional Anesthesia OR Opioid-Sparing OR Motor-Sparing). Filters applied: Journal Article, MEDLINE, Impact Quartile (Q1-Q2-Q3), Clinical Trials and RCTs, last 7 years. | 127 |
Scopus | TITLE–ABS–KEY: (Hip Arthroplasty OR Hip Fracture Surgery) AND (PENG OR Fascia Iliaca OR Femoral Block OR Lumbar Plexus OR Quadratus Lumborum) AND (Pain Control OR Opioid Reduction OR Recovery After Hip Surgery). Filters: Date 2018–2025, Peer-reviewed articles, English only. | 212 |
WOS | TS: (Hip Surgery OR Arthroplasty) AND (PENG OR Fascia Iliaca Block OR Femoral Block OR Quadratus Lumborum) AND (Analgesia OR Opioid Use OR Functional Recovery OR “Minimizing opioid use in orthopedic patients”). Refined by: Document type (Article), Years: 2018–2025, Indexes: SCI-EXPANDED, SSCI. | 181 |
Total | After removing duplicates | 402 |
Dimension/Variable | Inclusion Criteria | Exclusion Criteria |
---|---|---|
Topic and Objective | Studies on regional blocks in hip surgery (PENG, FICB, FNB, lumbar plexus, quadratus lumborum, sciatic, etc.), focused on pain control, functional recovery, and opioid reduction. | Studies on peripheral blocks in surgeries not related to the hip or not addressing postoperative analgesia. |
Design | Quantitative studies: randomized clinical trials, prospective and retrospective observational studies, meta-analyses, and systematic reviews. | Purely qualitative or anecdotal studies, expert opinions, and trials without structured methodology. |
Study Population | Adult patients (>18 years) undergoing hip surgery for fracture or arthroplasty, treated with locoregional anesthetic techniques. | Patients undergoing other surgeries or without a clear description of the surgical or block procedure. |
Geopolitical and Sociocultural Context | Studies conducted in hospital centers with surgical capacity and standardized postoperative follow-up. | Studies lacking a clinical framework or conducted in settings without rigorous medical supervision. |
Type of Publication | Peer-reviewed original articles, clinical trials, meta-analyses, and systematic reviews published in Q1, Q2, or Q3 journals. | Letters to the editor, conference abstracts, grey literature, and non-peer-reviewed articles. |
Language | English, Spanish, French, Portuguese, Italian, or German. | Any other language that does not allow for content validation. |
Publication Date | Last 7 years. | Studies published outside this time frame. |
Ethical Requirements | Specification of informed consent and approval by an institutional ethics committee. | Lack of explicit mention of ethical review or patient consent. |
Study | Bias Arising from the Randomization Process | Bias Due to Deviations from Intended Interventions | Bias Due to Missing Outcome Data | Bias in Measurement of the Outcome | Bias In Selection of The Reported Result | Overall Risk of Bias |
---|---|---|---|---|---|---|
Behrends et al. (2018) [7] | Some concerns | Low risk | Low risk | Low risk | Low risk | Some concerns |
Aliste et al. (2021) [8] | Low risk | Low risk | Low risk | Low risk | Low risk | Low risk |
Lee et al. (2024) [9] | Low risk | Low risk | Low risk | Low risk | Low risk | Low risk |
Vetrone et al. (2025) [10] | Low risk | Low risk | Low risk | Low risk | Low risk | Low risk |
Mosaffa et al. (2022) [11] | Low risk | Low risk | Low risk | Low risk | Low risk | Low risk |
Jeevendiran et al. (2024) [12] | Low risk | Low risk | Low risk | Low risk | Low risk | Low risk |
Pavithra et al. (2024) [13] | Low risk | Low risk | Low risk | Low risk | Low risk | Low risk |
Hu et al. (2023) [14] | Low risk | Low risk | Low risk | Low risk | Low risk | Low risk |
Natrajan et al. (2022) [15] | Low risk | Low risk | Low risk | Low risk | Low risk | Low risk |
Chaudhary et al. (2023) [16] | Low risk | Low risk | Low risk | Low risk | Low risk | Low risk |
Nuthep et al. (2023) [17] | Low risk | Low risk | Low risk | Low risk | Low risk | Low risk |
Allard et al. (2021) [18] | Low risk | Low risk | Low risk | Low risk | Low risk | Low risk |
Kong et al. (2022) [19] | Low risk | Low risk | Low risk | Low risk | Low risk | Low risk |
Braun et al. (2023) [20] | Some concerns | Low risk | Low risk | Low risk | Low risk | Some concerns |
(Et & Korkusuz 2023) [21] | Some concerns | Low risk | Low risk | Low risk | Low risk | Some concerns |
Hay et al. (2024) [22] | Low risk | Low risk | Low risk | Low risk | Low risk | Low risk |
Wan et al. (2024) [23] | Low risk | Low risk | Low risk | Low risk | Low risk | Low risk |
Authors | Study Objectives | Design | Sample Population | Intervention and Evaluation | Results and Conclusions |
---|---|---|---|---|---|
Matthias Behrends et al. (2018) [7] | To evaluate whether preoperative fascia iliaca block improves postoperative analgesia in hip arthroscopy. | Randomized, double-blind clinical trial | N = 80 patients undergoing hip arthroscopy (FICB: 40, placebo: 40) | Administration of 40 mL of 0.2% ropivacaine or saline placebo, plus a 10 mL intraarticular injection of 0.2% ropivacaine at the end of the procedure. Postoperative pain levels, opioid consumption, and quadriceps strength were assessed. | FICB did not significantly reduce postoperative pain or opioid consumption compared to placebo. However, it caused notable quadriceps weakness and more postoperative falls (4 vs. 1). Routine use of FICB is not recommended in hip arthroscopy due to lack of clear analgesic benefit and impaired mobility. |
Julián Aliste et al. (2021) [8] | To compare PENG block versus suprainguinal fascia iliaca block in patients undergoing total hip arthroplasty. | Randomized, double-blind clinical trial | N = 40 patients (PENG block: 20, suprainguinal FICB: 20) undergoing total hip arthroplasty under spinal anesthesia. | Administered 20 mL of 0.5% levobupivacaine with epinephrine for PENG block and 40 mL of 0.25% levobupivacaine for FICB. Quadriceps motor block, analgesia, opioid consumption, and functional recovery were evaluated. | PENG block significantly reduced quadriceps weakness at 3 h (45% vs. 90%, p < 0.001) and 6 h (25% vs. 85%, p < 0.001). It also better preserved hip adduction and reduced thigh sensory block (p ≤ 0.014). No differences in opioid use, postoperative pain, or hospital stay. Further research needed to optimize anesthetic volume and compare with other motor-sparing strategies. |
Tang Y. et al. (2023) [27] | To evaluate the early analgesic effect of ultrasound-guided PENG block in elderly patients with hip fractures. | Single-center, prospective, randomized controlled study | 60 elderly patients with hip fractures randomized to receive ultrasound-guided PENG block or systemic flurbiprofen axetil for early analgesia. | PENG block group showed significantly lower pain scores at rest and on movement at 30 min and 6 h post-block, reduced need for rescue analgesia, and better patient satisfaction. | The authors concluded that ultrasound-guided PENG block provides safe and effective early analgesia in elderly hip fracture patients. |
Lee, T.Y. et al. (2024) [9] | To compare PENG block with lumbar plexus block (LPB) in hip fracture surgery. | Randomized, double-blind clinical trial | N = 60 patients (PENG block: 30, LPB: 30) undergoing hip fracture surgery. | Administered 20 mL of 0.5% ropivacaine for PENG block and 40 mL of 0.25% ropivacaine for LPB. Analgesia, opioid use, and motor function were evaluated. | PENG block better preserved quadriceps strength at 6 h (26.7% vs. 80.0%; p < 0.001) and 12 h (20.0% vs. 56.7%; p = 0.010) compared to LPB. However, LPB led to lower opioid use at 24 h. |
Vetrone, F. et al. (2025) [10] | To compare PENG block combined with lateral femoral cutaneous nerve (LFCN) block versus FICB in total hip arthroplasty. | Retrospective comparative study | 80 patients (PENG+LFCN block: 57, FICB: 23) undergoing total hip arthroplasty. | Postoperative pain assessed with NRS, opioid consumption, and motor weakness evaluated with MRC scale at 6 h. | The PENG+LFCN group showed better motor preservation (MRC 4 vs. 3, p = 0.0001) and lower opioid consumption (7.5 MME vs. 60 MME, p = 0.001), with better pain control and reduced rescue opioid need compared to FICB. |
Faramarz Mosaffa et al. (2022) [11] | To compare the PENG block with the fascia iliaca block (FICB) in patients with hip fracture. | Randomized, double-blind, controlled clinical trial | 52 patients (FICB: 22, PENG block: 30), with stable, unstable, and femoral neck intertrochanteric fractures. | Blocks were applied and pain was measured using the VAS scale before the procedure, at 15 min, and up to 12 h postoperatively. | PENG block showed significantly lower pain at 15 min (p = 0.031) and 12 h (p = 0.021) compared to FICB. Lower total morphine consumption in 24 h with PENG block (p = 0.008). |
Shukai Li et al. (2024) [28] | Systematic review and meta-analysis on the efficacy and safety of PENG block in hip fracture surgery. | Meta-analysis of 15 randomized clinical trials | Total of 15 included studies, total N ≈ 890 patients. | Analgesic efficacy, quadriceps motor weakness, early mobilization, and postoperative pain were analyzed. | PENG block significantly reduced pain during positioning for spinal anesthesia (SMD = −0.35, 95% CI [−0.67, −0.02]; p = 0.04), decreased incidence of postoperative quadriceps weakness (RR = 0.11, 95% CI [0.01, 0.86]; p = 0.04), and was associated with earlier mobilization. No increase in opioid-related side effects was observed. |
Agustina De Santis et al. (2024) [29] | Narrative review on the efficacy and safety of PENG block in hip surgery. | Systematic review | Review of multiple studies from databases such as PubMed and Cochrane. | Studies on postoperative analgesia using PENG block and its comparison with other blocks were analyzed. | PENG block showed better control of postoperative pain and reduced opioid use. No serious adverse effects were reported. |
Liang Yu et al. (2023) [24] | Systematic review and meta-analysis on the efficacy of PENG block for postoperative analgesia in hip surgery. | Meta-analysis of 9 randomized clinical trials | N = 384 total patients (PENG block: 196, FICB: 188) | Postoperative morphine consumption over 24 h, time to first rescue analgesia, static and dynamic pain scores, and postoperative nausea and vomiting were assessed. | No significant difference in morphine consumption at 24 h (p = 0.08) or time to first rescue analgesia (p = 0.22). PENG block provided comparable analgesia to other blocks. |
Priscila P. Andrade et al. (2023) [25] | Meta-analysis on the efficacy of PENG block versus FICB in hip surgery. | Meta-analysis of 8 randomized clinical trials | N = 384 patients (PENG block: 196, FICB: 188) | Evaluation of static and dynamic pain at 6, 12, and 24 h, opioid use at 24 h, and time to first rescue analgesia. | PENG block reduced opioid consumption at 24 h (p = 0.04) and resting pain at 12 h (p = 0.02). No differences in dynamic pain or time to first rescue analgesia. |
Annamale Jeevendiran et al. (2024) [12] | To compare the analgesic efficacy of PENG block and femoral nerve block for positioning patients with hip fracture before spinal anesthesia. | Randomized, double-blind clinical trial | N = 70 patients with femoral neck, intertrochanteric, and subtrochanteric fractures (PENG block: 35, FNB: 35) | Administered 20 mL of 0.25% bupivacaine per block, VAS evaluated at 15 and 30 min post-block, rescue analgesia requirement and satisfaction measured. | PENG block showed lower VAS at 30 min (0.66 ± 1.05 vs. 1.94 ± 1.90, p = 0.001) and higher satisfaction from both patients and anesthesiologists. No significant differences in complications. |
Balachandran Pavithra et al. (2024) [13] | To compare the efficacy of PENG block versus anatomically guided fascia iliaca block for patient positioning prior to spinal anesthesia. | Randomized clinical trial | N = 80 patients with intertrochanteric hip fracture (FICB: 40, PENG block: 40) | Administered 30 mL of 0.5% ropivacaine per block. Time to passive leg lift, ease of positioning, and duration of postoperative analgesia were evaluated. | PENG block enabled faster leg elevation and easier positioning (p < 0.001), though FICB resulted in longer analgesia duration (p < 0.001). |
Hu J, Wang Q, Hu J, Kang P, Yang J (2023) [14] | To evaluate the efficacy of ultrasound-guided PENG block combined with local infiltration analgesia (LIA) for postoperative pain control in patients undergoing total hip arthroplasty. | Prospective, double-blind, randomized controlled trial. | 100 adult patients undergoing total hip arthroplasty randomized into two groups: PENG block + LIA versus femoral nerve block + LIA. | The PENG + LIA group had significantly lower VAS pain scores at 6, 12, and 24 hours postoperatively (p < 0.05), required less rescue opioid analgesia, and had a shorter time to first ambulation compared to the FNB + LIA group.. | Ultrasound-guided PENG block combined with LIA provides superior postoperative analgesia, reduced opioid consumption, and faster recovery compared with FNB + LIA in total hip arthroplasty. |
Natrajan et al. (2022) [15] | To compare PENG block with suprainguinal fascia iliaca block (SFIB) in total hip arthroplasty. | Randomized, double-blind clinical trial | N = 60 patients undergoing total hip arthroplasty (PENG block: 30, SFIB: 30) | Postoperative pain scores, morphine consumption at 24 and 48 h, and adverse events were assessed. | PENG block reduced morphine consumption at 24 h (8.0 mg vs. 10.0 mg, p < 0.001) and did not cause quadriceps weakness, unlike SFIB. |
Kinjal Chaudhary et al. (2023) [16] | To compare PENG block and FNB in proximal femur fractures prior to spinal anesthesia. | Randomized clinical trial | 60 patients with proximal femur fracture (PENG block: 30, FNB: 30) | Pain reduction with passive leg lift at 15°, and ease of positioning were evaluated. | PENG block significantly reduced pain (VAS: 6 vs. 5, p = 0.004) and provided longer postoperative analgesia. |
Luckapa Nuthep et al. (2023) [17] | To evaluate the analgesic effect of adding PENG block to suprainguinal FICB in hip fracture surgery. | Randomized, prospective clinical trial | 59 elderly patients undergoing hip fracture surgery (FICB only: 30, FICB+PENG: 29) | Pain scores at rest and movement at 12, 24, and 48 h, time to sit without pain, morphine use, and delirium incidence. | No significant differences in pain or mobilization time. Procedure duration was longer in FICB+PENG group (p < 0.001). |
Céline Allard et al. (2021) [18] | To compare PENG block with femoral block in femoral neck fractures. | Observational cohort study | 42 patients (Femoral block: 21, PENG block: 21) | Morphine consumption at 48 h, postoperative pain intensity, and limb mobility were evaluated. | No differences in morphine use or pain intensity. Greater quadriceps mobility in PENG group (5/5 vs. 2/5, p = 0.001). |
Mingjian Kong et al. (2022) [19] | To evaluate the analgesic efficacy of PENG block in intertrochanteric femur fractures. | Randomized, double-blind clinical trial | 50 patients (PENG block: 25, FICB: 25) | Pain at rest and during movement, intraoperative remifentanil use, and analgesia satisfaction were assessed. | PENG block showed better exercise analgesia at 6 h post-op (VAS: 2 vs. 6, p < 0.001) and lower use of remifentanil and fentanyl (p < 0.001). |
Braun AS et al. (2023) [20] | To compare analgesic efficacy of PENG block vs. quadratus lumborum block (QLB) after total hip arthroplasty under spinal anesthesia. | Retrospective study | Patients (N = 100, 50 PENG/50 No PENG block) undergoing primary THA under spinal anesthesia +/− block. | Retrospective comparison of patients receiving PENG or QL block. Pain, opioid use, and postoperative recovery were evaluated. | PENG block was comparable to QL block in pain control. Both provided effective analgesia. No clear differences in motor preservation or opioid use. Both suitable in multimodal approach. |
Et T, Korkusuz M. (2023) [21] | To compare PENG block, QLB, and intraarticular infiltration in total hip arthroplasty. | Randomized clinical trial | Patients (N = 90) undergoing primary total hip arthroplasty, divided into 3 groups (PENG block, QLB, intraarticular injection) | Pain intensity at 6 h post-op and opioid use among three groups were assessed. | PENG block and QLB provided better analgesia than intraarticular injection. No significant difference between PENG block and QLB in analgesic efficacy. |
Hay E, Kelly T, Wolf BJ, et al. (2024) [22] | To compare PENG block and lateral QLB on cumulative opioid use after total hip arthroplasty. | Randomized clinical trial | Adult patients undergoing primary total hip arthroplasty. N = 101 (50 PENG block/51 QLB) | Cumulative opioid use between 36 and 72 h post-op, pain scores, and adverse events were evaluated. | Lateral QLB led to lower cumulative opioid use vs. PENG block. Both were effective in pain control. |
Aslan M et al. (2025) [26] | To compare PENG + LFCN block versus anterior QLB for analgesia in total hip arthroplasty | Prospective, double-blind, randomized controlled trial. | N= 80 patients undergoing total hip arthroplasty were randomized to receive PENG + LFCN block or anterior QLB. | PENG + LFCN group had significantly lower 24-h morphine consumption (p = 0.027), better quadriceps strength preservation (0% vs 15% weakness in QLB group, p = 0.026), and improved resting analgesia at 24 h. | The authors concluded that PENG + LFCN provides superior motor preservation and reduced opioid use compared to anterior QLB in total hip arthroplasty. |
Wan L, Huang H, Zhang F, et al. (2024) [23] | To determine if PENG block is superior to other regional techniques in total hip arthroplasty. | Systematic review and network meta-analysis | A total of 14 clinical trials included (N = 1126 patients) with various regional techniques in hip surgery. | Incidence of quadriceps motor block, adverse events, and opioid requirement were compared. | PENG block showed the lowest incidence of quadriceps motor block and postoperative nausea and vomiting rates. |
Authors | Objective and Specific Design | Instruments | Information Approach | Data | Discussion | Validation | Methodology | Sample Eligibility | Representative Sample? |
---|---|---|---|---|---|---|---|---|---|
Matthias Behrends et al. (2018) [7] | YES | YES | YES | YES | YES | YES | YES | YES | YES |
Julián Aliste et al. (2021) [8] | YES | YES | YES | YES | YES | YES | YES | YES | YES |
Shukai Li et al. (2024) [28] | YES | YES | YES | YES | YES | YES | YES | YES | YES |
Lee, T.Y. et al. (2024) [9] | YES | YES | YES | YES | YES | YES | YES | YES | YES |
Vetrone, F. et al. (2025) [10] | YES | YES | YES | YES | YES | YES | YES | YES | YES |
Faramarz Mosaffa et al. (2022) [11] | YES | YES | YES | YES | YES | YES | YES | YES | YES |
Agustina De Santis et al. (2024) [29] | YES | YES | YES | YES | YES | YES | YES | YES | YES |
Liang Yu et al. (2023) [24] | YES | YES | YES | YES | YES | YES | YES | YES | YES |
Priscila P. Andrade et al. (2023) [25] | YES | YES | YES | YES | YES | YES | YES | YES | YES |
Annamale Jeevendiran et al. (2024) [12] | YES | YES | YES | YES | YES | YES | YES | YES | YES |
Balachandran Pavithra et al. (2024) [13] | YES | YES | YES | YES | YES | YES | YES | YES | YES |
Hu J et al. (2023) [14] | YES | YES | YES | YES | YES | YES | YES | YES | YES |
Natrajan et al. (2022) [15] | YES | YES | YES | YES | YES | YES | YES | YES | YES |
Kinjal Chaudhary et al. (2023) [16] | YES | YES | YES | YES | YES | YES | YES | YES | YES |
Luckapa Nuthep et al. (2023) [17] | YES | YES | YES | YES | YES | YES | YES | YES | YES |
Céline Allard et al. (2021) [18] | YES | YES | YES | YES | YES | YES | YES | YES | YES |
Mingjian Kong et al. (2022) [19] | YES | YES | YES | YES | YES | YES | YES | YES | YES |
Braun AS et al. (2023) [20] | YES | YES | YES | YES | YES | YES | YES | YES | YES |
Et T, Korkusuz M (2023) [21] | YES | YES | YES | YES | YES | YES | YES | YES | YES |
Hay E et al. (2024) [22] | YES | YES | YES | YES | YES | YES | YES | YES | YES |
Wan L et al. (2024) [23] | YES | YES | YES | YES | YES | YES | YES | YES | YES |
Outcome | Number of Studies | Certainty of Evidence | Justification |
---|---|---|---|
Postoperative pain reduction | 15 + RCTs and meta-analyses | Moderate | Low risk of bias but some variability in VAS scores and follow-up periods. |
Opioid consumption reduction | 12 + RCTs | High | Consistent results across trials showing reduction with PENG blocks. |
Motor preservation (quadriceps strength) | 10 + studies | High | Strong and reproducible effect; PENG block superior to FICB and FNB. |
Time to ambulation or functional recovery | 5–7 studies | Moderate | Limited data; outcome definitions varied across studies. |
Adverse effects (e.g., falls, PONV) | 8–10 studies | Low | Inconsistent reporting and heterogeneous outcome measures. |
Clinical Variable | Recommended Block | Justification |
---|---|---|
Intracapsular fracture | PENG block | Provides effective analgesia with minimal motor impairment. |
Extracapsular fracture | FICB or PENG+/−LFCN/Sciatic block | Greater analgesic coverage; PENG combination enhances motor sparing. |
Frail or elderly patient | PENG block | Reduces risk of falls and preserves mobility. |
Posterior surgical approach | PENG+/−Sciatic block | Ensures posterior innervation is covered. |
Goal: early mobilization | PENG or PENG+LFCN block | Preserves motor function and enables early ambulation. |
Delirium risk/opioid-sensitive | PENG block | Demonstrated opioid-sparing effect in some literature. |
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© 2025 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
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González Marcos, E.; Almagro Vidal, I.; Arranz Pérez, R.; Morillas Martinez, J.; Viudes, A.D.; Rodríguez Martín, A.; Gago Sánchez, A.J.; De Leániz, C.G.; Marín, D.R. Systematic Review of Hip Fractures and Regional Anesthesia: Efficacy of the Main Blocks and Comparison for a Multidisciplinary and Effective Approach for Patients in the Hospital Setting of Anesthesiology and Resuscitation. Surg. Tech. Dev. 2025, 14, 27. https://doi.org/10.3390/std14030027
González Marcos E, Almagro Vidal I, Arranz Pérez R, Morillas Martinez J, Viudes AD, Rodríguez Martín A, Gago Sánchez AJ, De Leániz CG, Marín DR. Systematic Review of Hip Fractures and Regional Anesthesia: Efficacy of the Main Blocks and Comparison for a Multidisciplinary and Effective Approach for Patients in the Hospital Setting of Anesthesiology and Resuscitation. Surgical Techniques Development. 2025; 14(3):27. https://doi.org/10.3390/std14030027
Chicago/Turabian StyleGonzález Marcos, Enrique, Inés Almagro Vidal, Rodrigo Arranz Pérez, Julio Morillas Martinez, Amalia Díaz Viudes, Ana Rodríguez Martín, Alberto José Gago Sánchez, Carmen García De Leániz, and Daniela Rodriguez Marín. 2025. "Systematic Review of Hip Fractures and Regional Anesthesia: Efficacy of the Main Blocks and Comparison for a Multidisciplinary and Effective Approach for Patients in the Hospital Setting of Anesthesiology and Resuscitation" Surgical Techniques Development 14, no. 3: 27. https://doi.org/10.3390/std14030027
APA StyleGonzález Marcos, E., Almagro Vidal, I., Arranz Pérez, R., Morillas Martinez, J., Viudes, A. D., Rodríguez Martín, A., Gago Sánchez, A. J., De Leániz, C. G., & Marín, D. R. (2025). Systematic Review of Hip Fractures and Regional Anesthesia: Efficacy of the Main Blocks and Comparison for a Multidisciplinary and Effective Approach for Patients in the Hospital Setting of Anesthesiology and Resuscitation. Surgical Techniques Development, 14(3), 27. https://doi.org/10.3390/std14030027