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Rebound Pain After Peripheral Nerve Block: A Review.

Wenqin Yin1, Dan Luo2,3, Haiqi Mi4,5

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Peripheral nerve blocks (PNB) offer effective pain relief, but rebound pain (RP) can occur after the block wears off. Dexamethasone or catheter use may help prevent RP after PNB.

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Area of Science:

  • Anesthesiology
  • Pain Management
  • Neurology

Background:

  • Peripheral nerve blocks (PNB) are increasingly used for perioperative analgesia, often guided by ultrasound.
  • Multimodal analgesia strategies incorporating PNBs are replacing traditional opioid-based pain management.
  • Rebound pain (RP) is a significant concern, potentially negating the benefits of PNBs if not managed.

Purpose of the Study:

  • To review the definitions, clinical signs, risk factors, pathophysiology, and prevention strategies for rebound pain (RP) following peripheral nerve blocks (PNB).
  • To identify characteristics and high-risk factors associated with RP after PNB.
  • To provide recommendations for the optimal use of PNBs in clinical anesthesia.

Main Methods:

  • Literature review of existing studies on peripheral nerve blocks and rebound pain.
  • Analysis of definitions, clinical manifestations, and etiological factors of RP.
  • Evaluation of various prevention and management strategies for RP.

Main Results:

  • The exact mechanism of RP after PNB remains unclear, though shared pathways in pain transmission are suggested.
  • A single PNB with dexamethasone is identified as a reliable preventive regimen.
  • The use of a catheter for PNB is considered a more reliable method for reducing RP incidence.

Conclusions:

  • RP following PNB is a critical issue that requires careful consideration and management.
  • While dexamethasone shows promise, catheter use appears to be a more robust strategy for preventing RP.
  • This review offers guidance for the appropriate application of PNBs as adjunctive analgesics in anesthesia.