Rebound Pain After Peripheral Nerve Blocks

Peripheral nerve blocks are increasing in use for both anesthesia and analgesia. Despite the benefits they present in opioid reduction, clinicians are increasingly recognizing rebound pain as a significant side effect. Rebound pain refers to the sudden onset of severe pain that occurs when the block wears off. While most patients will experience excellent pain relief from regional anesthesia, the sudden onset of pain can be intense, distressing, and difficult to manage. Current evidence suggests that up to 40% of patients receiving single-shot peripheral nerve blocks can experience significant rebound pain, though this widely varies among surgeries and the patient population. The mechanisms involved appear more complex than just the absence of the block; they include inflammatory responses following surgical trauma, abrupt reactivation of pain pathways, and patient factors such as baseline pain levels and psychological vulnerability. A range of preventive strategies aimed at reducing its effect has been studied. Multimodal analgesia, intravenous and perineural dexamethasone administration, continuous peripheral nerve block techniques, and structured patient education have all demonstrated potential benefits in reducing rebound pain severity or incidence. However, variations in study design, patient populations, and outcome measures make definitive clinical recommendations challenging. This paper explores our current understanding of rebound pain, examines key clinical trials, and discusses practical considerations for the multidisciplinary team supporting postoperative recovery.