Postoperative analgesic outcomes of fascia iliaca compartment block versus pericapsular nerve group block in hip fracture surgery: a retrospective observational study

Hip fracture surgery is associated with substantial postoperative pain, delayed mobilization, and increased opioid requirements, particularly in older adults. Ultrasound-guided regional nerve blocks are increasingly used as components of multimodal analgesia. This study compared postoperative analgesic outcomes between fascia iliaca compartment block (FICB) and pericapsular nerve group (PENG) block in patients undergoing hemiarthroplasty for hip fracture. This retrospective single-center cohort study included all 186 eligible adult patients who underwent hemiarthroplasty for hip fracture under spinal anesthesia between October 2022 and October 2024. Patients received either ultrasound-guided FICB ( n = 90) or PENG block ( n = 96) before surgery. The primary outcome was postoperative visual analogue scale (VAS) score at 6 h. Secondary outcomes included VAS score at 24 h, cumulative tramadol consumption during the first postoperative 24 h, quality of recovery assessed using the QoR-15, hospital length of stay, and intraoperative hemodynamic parameters. Separate multivariable linear regression models were used to adjust for age, sex, and ASA physical status. Baseline characteristics were comparable between groups. Patients receiving PENG block had significantly lower postoperative VAS scores at 6 h (3.42 ± 0.90 vs. 5.04 ± 1.24; mean difference − 1.63, 95% CI − 1.94 to − 1.32; p < 0.001) and at 24 h (5.29 ± 0.86 vs. 6.40 ± 0.91; mean difference − 1.11, 95% CI − 1.36 to − 0.85; p < 0.001). Cumulative 24-hour tramadol consumption was significantly lower in the PENG group (243.98 ± 54.27 mg vs. 347.89 ± 65.87 mg; mean difference − 103.91 mg, 95% CI − 121.32 to − 86.49; p < 0.001). QoR-15 scores were significantly higher following PENG block (91 [88–93] vs. 83 [80–85]; p < 0.001). After adjustment for age, sex, and ASA physical status, PENG block remained independently associated with lower VAS scores at 6 and 24 h and lower 24-hour tramadol consumption. Compared with FICB, PENG block was associated with lower postoperative opioid requirements, lower early postoperative pain scores, and improved patient-reported quality of recovery following hemiarthroplasty for hip fracture. The reduction in postoperative tramadol consumption appears to represent the most clinically relevant finding. Prospective randomized multicenter studies are warranted to confirm these observations.