Five randomized controlled trials including 808 patients undergoing total hip arthroplasty were included in this systematic review and meta-analysis comparing PENG block versus placebo. Pooled outcomes of interest included pain score in the post-anesthesia care unit (PACU), pain scores at 6, 24, and 48 hours postoperatively, time to first opioid use, total opioid consumption at 24 and 48 hours, and incidence of complications. The results indicated that PENG block significantly reduced pain scores in PACU and at 6 hours, extended the time to first opioid use, and reduced opioid consumption at 24 and 48 hours postoperatively. The main findings suggest that PENG block is effective in early postoperative pain management and reducing opioid use, though more high-quality studies are needed to confirm these results.