Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Current Pain and Headache Reports
Published in: Current Pain and Headache Reports 9/2023

30-06-2023 | Nerve Block | Acute Pain Medicine (R Urman, Section Editor)

Postoperative Rebound Pain: Our Current Understanding About the Role of Regional Anesthesia and Multimodal Approaches in Prevention and Treatment

Authors: Elizabeth Luebbert, Meg A. Rosenblatt

Published in: Current Pain and Headache Reports | Issue 9/2023

Login to get access

Abstract

Purpose of Review

Rebound pain (RP) is a common occurrence after peripheral nerve block placement, especially when blocks are used for orthopedic surgery. This literature review focuses on the incidence and risk factors for RP as well as preventative and treatment strategies.

Recent Findings

The addition of adjuvants to a block, when appropriate, and starting patients on oral analgesics prior to sensory resolution are reasonable approaches. Using continuous nerve block techniques can provide extended analgesia through the immediate postoperative phase when pain is the most intense.

Summary

Peripheral nerve blocks (PNBs) are associated with RP, a frequent phenomenon that must be recognized and addressed to prevent short-term pain and patient dissatisfaction, as well as long-term complications and avoidable hospital resource utilization. Knowledge about the advantages and limitations of PNBs allows the anesthesiologists to anticipate, intervene, and hopefully mitigate or avoid the phenomenon of RP.
Literature
1.
Lavand’homme P. Rebound pain after anesthesia in the ambulatory patient. Curr Opin Anesth. 2018;31:679–684.
2.
Gerbershagen HJ, Pogatzki-Zahn E, Aduckathil S, et al. Procedure-specific risk factor analysis for the development of severe postoperative pain. Anesth. 2014;120:1237–45.CrossRef
3.
de Oliveira RM, Tenorio SB, Tanaka PP, Precoma D. Control of pain through epidural block and incidence of cardiac dysrhythmias in postoperative period of thoracic and major abdominal surgical procedures: a comparative study. Rev Bras Aneseth. 2012;62:10–8.CrossRef
4.
Shea RA, Brooks JA, Dayhoff NE. Keck J Pain intensity and postoperative pulmonary complications among the elderly after abdominal surgery. Heart Lung. 2002;31:440–9.CrossRefPubMed
5.
Fletcher D, Stamer UM, Pogatzki-Zahn E, et al. Chronic postsurgical pain in Europe: an observational study. Eur J Anaesth. 2015;32:725–34.CrossRef
6.
McGrath B, Elgendy H, Chung F, et al. Thirty percentage of patients have moderate to severe pain 24 hr after ambulatory surgery: a survey of 5,703 patients. Can J Anaesth. 2004;51:886–91.CrossRefPubMed
7.
Joshi G, Ghandi K, Shah N, et al. Peripheral nerve blocks in the management of postoperative pain: challenges and opportunities. J Clin Anesth. 2016;35:524–9.CrossRef
8.
Egol KA, Soojian MG, Walsh M. Regional anesthesia improves outcome after distal radius fracture fixation over general anesthesia. J Orthop Trauma. 2012;26:545–9.CrossRefPubMed
9.
Sunderland S, Yarnhold CH, Head SJ, et al. Regional versus general anesthesia and the incidence of unplanned health care resource utilization for postoperative pain after wrist fracture surgery: results from retrospective quality improvement project. Reg Anesth Pain Med. 2016;41:22–7.CrossRefPubMed
10.
Dada O, Gonzalez Zacarias A, Ongaigui C, et al. Does rebound pain after peripheral nerve block for orthopedic surgery impact postoperative analgesia and opioid consumption? A narrative review. Int J Environ Res Public Health. 2019;16:3257.CrossRefPubMedPubMedCentral
11.
• Hade A, Okano S, Pelecanos A, et al. Factors associated with low levels of patient satisfaction following peripheral nerve block. Sage J. 2021;49:125–32. Source 11 (from 3/2021) detailed the reality of RP in contributing to patient dissatisfaction scores and how this phenomenon cannot be ignored and must be addressed.
12.
Henningsen MJ, Sort R, Møller AM, et al. Peripheral nerve block in ankle fracture surgery: a qualitative study of patients’ experiences. Anaesth. 2018;73:49–58.CrossRef
13.
• Barry G, Bailey JG, Sardinha J, et al. Factors associated with rebound pain after peripheral nerve block for ambulatory surgery. Br J Anaesth. 2021;126:862–71. Source 13 (from 2021) laid the groundwork for exploring the factors associated with RP and how RP can be prevented.
14.
Touil N, Pavlopoulou A, Barbier O, et al. Evaluation of intraoperative ketamine on the prevention of severe rebound pain upon cessation of peripheral nerve block: a prospective randomized, double-blind, placebo controlled study. Br J Anaesth. 2022;128:734–41.CrossRefPubMed
15.
Munoz-Levya F, Cubillos J, Chin KJ. Managing rebound pain after regional anesthesia. Korean J Anesth. 2020;73:372–83.CrossRef
16.
Nobre LV, Cunha GP, Branco de Sousa PCC, et al. Peripheral nerve block and rebound pain: literature review. Rev Bras Anest. 2019;69:587–93.
17.
Kolarczyk LM, Williams BA. Transient heat hyperalgesia during resolution of ropivacaine sciatic nerve block in the rat. Reg Anesth Pain Med. 2011;36:220–4.CrossRefPubMedPubMedCentral
18.
Morita S, Oizumi N, Suenaga N, et al. Dexamethasone added to levobupivacaine prolongs the duration of interscalene brachial plexus block and decreases rebound pain after arthroscopic rotator cuff repair. J Shoudler Elbow Surg. 2020;29:1751–7.CrossRef
19.
Jen TTH, Ke JXC, Wing KJ, et al. Development of internal validation of a multivariable risk prediction model for severe rebound pain after foot and ankle surgery involving single-shot popliteal sciatic nerve block. Br J Anaesth. 2022;129:127–35.CrossRefPubMed
20.
Abdallah FW, Halpern SH, Aoyama K, Brull R. Will the real benefits of single shot interscalene block please stand up? A systemic revie wand meta-analysis. Anesth Analg. 2015;120:1114–29.CrossRefPubMed
21.
Komen H, Brunt LM, Deych E, et al. Intraoperative methadone in same-day ambulatory surgery: a randomized, double-blinded, dose-finding pilot study. Anesth Analg. 2019;128:802–10.CrossRefPubMedPubMedCentral
22.
Bruhn J. Pain rebound in day surgery: how can we avoid it? Reg Anesth Pain Med. 2019;44:A8–10.
23.
Zhu T, Gao Y, Xu X, et al. Effect of ketamine added to ropivacaine in nerve block for postoperative pain management in patients undergoing anterior cruciate ligament reconstruction: a randomized trial. Clin Ther. 2020;42:882–91.CrossRefPubMed
24.
Zangrilli J, Szukics P, Austin L, et al. Perioperative pain management in ambulatory and inpatient shoulder surgery. JBJS Reviews. 2021;9:1–10.CrossRef
25.
Kunkle B, Kothandaraman V, Goodloe J, et al. Orthopaedic application of cryotherapy JBJS Reviews. 2021;9:1–20.
26.
Dawson S, Loewenstein SS, rebound pain after peripheral nerve block for ambulatory extremity surgery is an underappreciated problem. Comment on Br J Anaesth. 126:862–71. Br J Anaesth. 2021(126):e204–205.
27.
Munoz-Leyva F, Cubillos J, Chin KJ. Managing rebound pain after regional anesthesia. Korean J Anesth. 2020;73:372–83.CrossRef
28.
Williams BA, Bottegal MT, Kentor ML, et al. Rebound pain scores as a function of femoral nerve block duration after anterior cruciate ligament reconstruction: retrospective analysis of a prospective, randomized clinical trial. Reg Anesth Pain Med. 2007;32:186–92.PubMedPubMedCentral
29.
Kim JH, Koh HJ, Dong KK, et al. Interscalene brachial plexus bolus block versus patient-controlled interscalene indwelling catheter analgesia for the first 48 hours after arthroscopic rotator cuff repair. J Shoulder Elbow Surg. 2018;27:1243–50.CrossRefPubMed
30.
Ganta A, Ding D, Fisher N, et al. Continuous infraclavicular brachial plexus block versus single-shot nerve block for distal radius surgery: a prospective randomized control trial. Orthop Trauma. 2018;32:22–6.
31.
Ding DY, Manoli A III, Galos D. Continuous popliteal sciatic nerve block versus single injection nerve block for ankle fracture surgery: a prospective randomized comparative trial. J Orthop Trauma. 2015;29:392–8.CrossRef
32.
Knight JB, Schott NJ, Kentor ML, et al. Neurotoxicity of common peripheral nerve adjuvants. Curr Opin Anaesth. 2015;28:598–604.CrossRef
33.
Williams BA, Ibinson JW, Mangione MP. Research priorities regarding multimodal peripheral nerve blocks for postoperative analgesia and anesthesia based on hospital quality data extracted from over 1,300 cases (2011–2014). Pain Med. 2015;16:7–12.CrossRefPubMed
34.
An K, Elkassabany NM, Liu J. Dexamethasone as adjuvant to bupivacaine prolongs the duration of thermal antinociception and prevents bupivacaine-induced rebound hyperalgesia via regional mechanism in a mouse sciatic nerve block model. PLoS ONE. 2015;10:e0123459.CrossRefPubMedPubMedCentral
35.
Woo JH, Lee HJ, Oh HW, et al. Perineural dexamethasone reduces rebound pain after ropivacaine single injection interscalene block for arthroscopic shoulder surgery: a randomized controlled trial. Reg Anesth Pain Med. 2021;46:965–70.CrossRefPubMed
36.
El-Boghdadly K, Brull R, Sehmbi H, et al. Perineural dexmedetomidine is more effective than clonidine when added to local anesthetic for supraclavicular brachial plexus block: a systemic revie wand meta-analysis. Anesth Analg. 2017;124:2008–20.CrossRefPubMed
Metadata
Title
Postoperative Rebound Pain: Our Current Understanding About the Role of Regional Anesthesia and Multimodal Approaches in Prevention and Treatment
Authors
Elizabeth Luebbert
Meg A. Rosenblatt
Publication date
30-06-2023
Publisher
Springer US
Published in
Current Pain and Headache Reports / Issue 9/2023
Print ISSN: 1531-3433
Electronic ISSN: 1534-3081
DOI
https://doi.org/10.1007/s11916-023-01136-z

Other articles of this Issue 9/2023

Current Pain and Headache Reports 9/2023 Go to the issue

Episodic Migraine (S Parikh, Section Editor)

Cognitive Behavioral Therapy for the Management of Episodic Migraine

Acute Pain Medicine (R Urman, Section Editor)

Perioperative Use of Ketamine

Episodic Migraine (S Parikh, Section Editor)

The Potential of Psychedelics for the Treatment of Episodic Migraine

Alternative Treatments for Pain Medicine (M Jones, Section Editor)

Acupuncture for Low Back Pain: Reevaluation of Systematic Reviews and Meta-analyses

Episodic Migraine (S Parikh, Section Editor)

A Brief Review of Gepants

Acute Pain Medicine (R Urman, Section Editor)

Addressing Bias in Acute Postoperative Pain Management