Peripheral nerve block and rebound pain: literature review

Nobre, Layana Vieira; Cunha, Graziella Prianti; Sousa, Paulo Cesár Castello Branco de; Takeda, Alexandre; Ferraro, Leonardo Henrique Cunha

doi:10.1016/j.bjane.2019.10.009

Cited by 18 publications

(17 citation statements)

References 50 publications

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“…Pain is often prominent when the effects of a single shot peripheral block wears off. The experience of this phenomeneon noted at block resolution is usually refered to as “rebound pain” [ 6 ]. Several studies have high-lighted the risk for “rebound pain” when the regional anaesthesia wears off [ 7 – 12 ].…”

Section: Introductionmentioning

confidence: 99%

Supraclavicular block with Mepivacaine vs Ropivacaine, their impact on postoperative pain: a prospective randomised study

et al. 2021

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Background Supraclavicular block (SCB) with long-acting local anaesthetic is commonly used for surgical repair of distal radial fractures (DRF). Studies have shown a risk for rebound pain when the block fades. This randomised single-centre study aimed to compare pain and opioid consumption the first three days post-surgery between SCB-mepivacaine vs. SCB-ropivacaine, with general anaesthesia (GA) as control. Methods Patients (n = 90) with ASA physical status 1–3 were prospectively randomised to receive; SCB with mepivacine 1%, 25–30 ml (n = 30), SCB with ropivacaine 0.5%, 25–30 ml (n = 30) or GA (n = 30) with propofol/fentanyl/sevoflurane. Study objectives compared postoperative pain with Numeric Rating Scale (NRS) and sum postoperative Opioid Equivalent Consumption (OEC) during the first 3 days post-surgery between study-groups. Results The three groups showed significant differences in postoperative pain-profile. Mean NRS at 24 h was significantly lower for the SCB-mepivacaine group (p = 0.018). Further both median NRS and median OEC day 0 to 3 were significanly lower in the SCB-mepivacaine group as compared to the SCB-ropivacaine group during the first three days after surgery; pain NRS 1 (IQR 0.3–3.3) and 2.7 (IQR 1.3–4.2) (p = 0.017) and OEC 30 mg (IQR 10–80) and 85 mg (IQR 45–125) (p = 0.004), respectively. The GA-group was in between both in pain NRS and median sum OEC. Unplanned healthcare contacts were highest among SCB-ropivacaine patients (39.3%) vs. SCB-mepivacaine patients (0%) and GA-patients (3.4%). Conclusions The potential benefit of longer duration of analgesia, associated to a long-acting local anaesthetic agent, during the early postoperative course must be put in perspective of potential worse pain progression following block resolution. Trial registration NCT03749174 (clinicaltrials.gov, Nov 21, 2018, retrospectively registered).

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Section: Introductionmentioning

confidence: 99%

Supraclavicular block with Mepivacaine vs Ropivacaine, their impact on postoperative pain: a prospective randomised study

et al. 2021

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“…Risk factors for rebound pain include younger age, 21 shorter duration of block, 22 and ineffective pain control, while a peripheral nerve block wears off. 23,24 In a thematic analysis of patients receiving blocks, Henningsen et al 25 characterized patients’ experience of rebound pain as severe, concerning pain that does not respond to morphine. The sudden, severe pain is frightening for the patient and may lead him or her to seek further care.…”

Section: Discussionmentioning

confidence: 99%

Emergency Department Utilization After Administration of Peripheral Nerve Blocks for Upper Extremity Surgery

Loewenstein

Bamba

Adkinson

2020

Hand (New York, N,Y.)

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Background The purpose of this study was to determine the impact of upper extremity peripheral nerve blocks on emergency department (ED) utilization after hand and upper extremity surgery. Methods We reviewed all outpatient upper extremity surgeries performed in a single Midwestern state between January 2009 and June 2019 using the Indiana Network for Patient Care. These encounters were used to develop a database of patient demographics, comorbidities, concurrent procedures, and postoperative ED visit utilization data. We performed univariate, bivariate, and multivariate logistic regression analyses. Results Among 108 451 outpatient surgical patients, 9079 (8.4%) received blocks. Within 1 week of surgery, a greater proportion of patients who received peripheral nerve blocks (1.4%) presented to the ED than patients who did not (0.9%) ( P < .001). The greatest risk was in the first 2 postoperative days (relative risk, 1.78; P < .001). Pain was the principal reason for ED utilization in the block cohort (53.6%) compared with those who did not undergo a block (35.1%) ( P < .001). When controlling for comorbidities and demographics, only peripheral nerve blocks (adjusted odds ratio [OR], 1.71; P = 0.007) and preprocedural opioid use (adjusted OR, 1.43; P = .020) conferred an independently increased risk of ED utilization within the first 2 postoperative days. Conclusions Peripheral nerve blocks used for upper extremity surgery are associated with a higher risk of unplanned ED utilization, most likely related to rebound pain. Through proper patient education and pain management, we can minimize this unnecessary resource utilization.

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“…The pathophysiology of rebound pain has not been fully understood and no effective precautions and treatments are available currently. 8 Continuous PNB and perineural dexamethasone in single injection PNB have been suggested to prevent rebound pain. 3 , 9 , 10 However, there are many concerns with these strategies because persistent PNB hinders rehabilitation and the perineural use of dexamethasone is off-label.…”

Section: Introductionmentioning

confidence: 99%

“…The rebound pain may be caused by multiple pathogenic mechanisms, such as surgical mechanical injury, proinflammation and neurotoxicity of local anesthetics retention and amplification of nociceptive signal memory when PNB wear off, or a combination of these. 8 , 11 Animal studies demonstrated that the proinflammation and neurotoxicity of ropivacaine induced transient thermal hyperalgesia response in rats with sciatic nerve blockade, which might be one of the potential pathophysiologic mechanisms in rebound pain. 12 , 13 This thermal hyperalgesia may be cause by abnormal spontaneous C-fiber hyperactivity and nociceptor hyperexcitability.…”

Section: Introductionmentioning

confidence: 99%

Effect of Transauricular Vagus Nerve Stimulation on Rebound Pain After Ropivacaine Single Injection Femoral Nerve Block for Anterior Cruciate Ligament Reconstruction: A Randomized Controlled Trial

Zhou¹,

Yu²,

Yin³

et al. 2022

JPR

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Purpose The aim of this study was to investigate whether transauricular vagus nerve stimulation (taVNS) could reduce the incidence of rebound pain in patients undergoing anterior cruciate ligament reconstruction (ACLR) under general anesthesia combined with preoperative femoral nerve block. Methods In total, 78 patients were enrolled in this prospective, randomized, double-blind, and sham-controlled study. Patients were randomly assigned to 2 groups (n=39): Group taVNS received taVNS (1h /1time, 6times) within the first 12 h after surgery; Group SS received sham stimulation (SS) in the same manner. Pain scores at 0, 4, 8, 12, 24, 48 h after surgery were assessed with Numeric Pain Rating Scale (NRS). The incidence, duration and onset of rebound pain were recorded. In addition, additional analgesic requirements and side effects in the first 48 h postoperatively, as well as sleep disturbance on the night of surgery, were examined. Results The incidence and duration of rebound pain were lower in the taVNS group than in the SS group ( P =0.025 and P =0.015, respectively). Pain scores at 8 h and 12 h postoperatively were significantly lower in the taVNS group compared with the SS group ( P <0.05). The number of times to press the patient-controlled analgesia (PCA) pump and the number of patients requiring additional analgesic were significantly lower in the taVNS group than in the SS group until 12 h after surgery ( P =0.021 and P =0.004, respectively). The number of patients with sleep disturbance in the taVNS group was lower than that in the SS group ( P =0.030). Conclusion The taVNS exerts beneficial effect on rebound pain after femoral nerve block in patients undergoing ACLR, which reduces the incidence and duration of rebound pain, the need for postoperative additional analgesic, and the number of complications.

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Peripheral nerve block and rebound pain: literature review

Cited by 18 publications

References 50 publications

Supraclavicular block with Mepivacaine vs Ropivacaine, their impact on postoperative pain: a prospective randomised study

Supraclavicular block with Mepivacaine vs Ropivacaine, their impact on postoperative pain: a prospective randomised study

Emergency Department Utilization After Administration of Peripheral Nerve Blocks for Upper Extremity Surgery

Effect of Transauricular Vagus Nerve Stimulation on Rebound Pain After Ropivacaine Single Injection Femoral Nerve Block for Anterior Cruciate Ligament Reconstruction: A Randomized Controlled Trial

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