Fifteen randomized controlled trials including 890 patients with hip fractures were included in this systematic review and meta-analysis comparing the pericapsular nerve group (PENG) block vs. no PENG block under spinal anesthesia. Pooled outcomes of interest included pain scores during position placement, postoperative pain scores at various time intervals, incidence of postoperative hypokinesia, and time to first ambulation. The pooled results showed that the PENG block significantly reduced pain scores during positioning and at 48 hours postoperatively, reduced the incidence of postoperative hypokinesia, and advanced the time to first walking. These findings suggest that the PENG block is beneficial for managing postoperative pain and promoting early recovery in hip fracture surgery under spinal anesthesia.