Rebound Pain and Patient Satisfaction With Dexamethasone as an Adjunct for Peripheral Nerve Blocks. A Substudy Based...

Area of Science:

• Anesthesiology
• Pain Management
• Pharmacology

Background:

• Peripheral nerve blocks (PNBs) are crucial for postoperative pain control, but their limited duration can lead to rebound pain.
• Adjunct dexamethasone, a synthetic glucocorticoid, is investigated for its potential to extend PNB duration and mitigate rebound pain.

Purpose of the Study:

• To assess the effect of dexamethasone, administered orally or intravenously, on pain experienced immediately after peripheral nerve block cessation.
• To evaluate the impact of dexamethasone on the incidence of rebound pain following osseous surgery.

Main Methods:

• A substudy pooled data from two randomized, placebo-controlled trials involving 159 participants undergoing osseous surgery under PNB.
• Participants received either oral or intravenous dexamethasone or a placebo.
• Primary outcomes included pain scores (Numerical Rating Scale) after block cessation and the occurrence of rebound pain (NRS ≥ 7).

Main Results:

• Dexamethasone significantly reduced median pain scores after block cessation compared to placebo (3.0 vs. 5.0).
• The incidence of rebound pain was lower in the dexamethasone group (18.4%) than in the placebo group (35.7%).
• Dexamethasone demonstrated a statistically significant reduction in both post-block pain and the risk of rebound pain (p < 0.001 and p = 0.014, respectively).

Conclusions:

• Adjunct dexamethasone effectively reduces postoperative pain after peripheral nerve block cessation.
• Dexamethasone administration significantly lowers the risk of experiencing rebound pain.
• No significant association was found between patient satisfaction and rebound pain, though satisfaction measures showed a ceiling effect.