Prevalence and Predictors of Severity of Rebound Pain After Regional Anesthesia in Patients Undergoing Orthopedic...

Rebound pain (RP) is an acute, burning, or dull-aching type of pain that occurs following the resolution of regional anesthesia. It is a common but understudied problem in orthopedic patients undergoing surgery under regional anesthesia. This study aimed to determine the prevalence and predictors of RP severity in patients undergoing orthopedic surgeries.

A cross-sectional study was conducted involving 364 patients who underwent orthopedic surgery and received regional anesthesia. To determine factors associated with the severity of RP, bivariable and multivariable ordinal logistic regression analyses were conducted. Both crude and adjusted odds ratios with their corresponding 95% confidence interval were calculated to determine the strength of association.

The prevalence of RP after resolution of regional anesthesia was 70.9% (95% CI: 65.9-75.5). Among all participants, 30.2% experienced mild RP, 19.2% had moderate pain, and 21.4% reported severe RP. Age less than 60 years (AOR: 2.34, 95% CI: 1.38-3.95, and p :  0.001), ASA physical status III or above (AOR: 5.84, 95% CI: 2.17-15.69, and p < 0.001), and having moderate (AOR: 2.86, 95% CI: 1.21-6.78, and p : 0.017) and severe (AOR: 7.48, 95% CI: 4.09-13.68, and p < 0.001) preoperative pain were significantly associated with increased odds of RP. In contrast, premedication with intravenous dexamethasone (AOR: 0.24, 95% CI: 0.14-0.43, and p < 0.001) and using local anesthetic adjuvants (AOR: 0.05, 95% CI: 0.02-0.11, and p < 0.001) were significantly associated with reduced odds of severe RP.

Our study found a high incidence of RP following the resolution of regional anesthesia in patients undergoing orthopedic surgery. To reduce its incidence and severity, it is essential to effectively manage and alleviate preoperative pain, incorporate local anesthetic adjuvants into nerve block solutions, utilize intravenous dexamethasone, and incorporate multimodal analgesia before the resolution of regional anesthesia.