Rebound Pain After Peripheral Nerve Block: A Review

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.