Rebound pain: distinct pain phenomenon or nonentity?

Hamilton, Duncan

doi:10.1016/j.bja.2020.12.034

Cited by 14 publications

(10 citation statements)

References 28 publications

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“…The term ‘rebound pain’ was recently introduced to describe the temporary, acute postoperative pain that occurs after regional anesthesia sensory block has worn off, and which can be observed following peripheral nerve block and intraspinal anesthesia ( 1 ). To date, there is no clear definition of rebound pain.…”

Section: Introductionmentioning

confidence: 99%

“…To better quantify rebound pain, Barry et al ( 2 ) proposed a standardized reporting method: if the pain level transitions from well-controlled [numerical rating scale (NRS) ≤ 3] to severe (NRS ≥ 7) within 24 h after regional block, rebound pain is considered to have occurred. The mechanism of rebound pain is unclear, but may be explained by relatively sudden nociceptive pain from insufficient preemptive analgesia or regional block-induced hyperalgesia ( 1 , 3 ). Other factors may include local anesthetic neurotoxicity, withdrawal reactions, potential pain-promoting effects, and individual or surgical factors ( 4 ).…”

Section: Introductionmentioning

confidence: 99%

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Effects of esketamine on postoperative rebound pain in patients undergoing unilateral total knee arthroplasty: a single-center, randomized, double-blind, placebo-controlled trial protocol

Zhu

Liu

et al. 2023

Front. Neurol.

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IntroductionRebound pain, transient and acute postoperative pain after the disappearance of regional block anesthesia, has been a concern in recent years. Insufficient preemptive analgesia and hyperalgesia induced by regional block are the main mechanisms. At present, the evidence for the treatment of rebound pain is limited. The esketamine, as an antagonist of the N-methyl-D-aspartate receptor, has been proven to prevent hyperalgesia. Therefore, this trial aims to evaluate the impact of esketamine on postoperative rebound pain in patients undergoing total knee arthroplasty.Methods/designThis study is a single-center, prospective, double-blind, randomized, placebo-controlled trial. Participants who plan to undergo total knee arthroplasty will be randomly assigned to the esketamine group (N = 178) and placebo group (N = 178) in a ratio of 1:1. This trial aims to evaluate the impact of esketamine on postoperative rebound pain in patients undergoing total knee arthroplasty. The primary outcome of this trial is the incidence of rebound pain within 12 h after the operation in the esketamine group and the placebo group. The secondary outcome will be to compare (1) the incidence of rebound pain 24 h after the operation; (2) the time to enter the pain cycle for the first time within 24 h after the procedure; (3) the first time of rebound pain occurred within 24 h after surgery; (4) the modified rebound pain score; (5) NRS score under rest and exercise at different time points; (6) the cumulative opioid consumption at different time points; (7) patient’s prognosis and knee joint function evaluation; (8) blood glucose and cortisol concentration; (9) patient’s satisfaction score; (10) adverse reactions and adverse events.DiscussionThe effect of ketamine on preventing postoperative rebound pain is contradictory and uncertain. The affinity of esketamine to the N-methyl-D-aspartate receptor is about four times higher than levo-ketamine, the analgesic effect is 3 times higher than levo-ketamine, and there are fewer adverse mental reactions. To our knowledge, there is no randomized controlled trial to verify the impact of esketamine on postoperative rebound pain in patients undergoing total knee arthroplasty. Therefore, this trial is expected to fill an important gap in relevant fields and provide novel evidence for individualized pain management.Clinical Trial Registrationhttp://www.chictr.org.cn, identifier ChiCTR2300069044.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effects of esketamine on postoperative rebound pain in patients undergoing unilateral total knee arthroplasty: a single-center, randomized, double-blind, placebo-controlled trial protocol

Zhu

Liu

et al. 2023

Front. Neurol.

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“…Pain scores are significantly lower using cPNB 40,41,48,[50][51][52][53] . Rebound pain occurs in up to 50% of patients and is most intense after bone-related surgery 50,54,55 . Catheter-related complications occur in up to 30% of cases, the most common being leakage 40,52,56 .…”

Section: Pnb Related Complicationsmentioning

confidence: 99%

Safety and follow-up systems after ambulatory peripheral nerve block: a narrative review

Gille,

Vermeulen,

Teunkens

2022

Acta Anaest Belg

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Background: Ambulatory surgery has grown during the last decades, and Peripheral Nerve Blocks (PNB) are widely used for perioperative and postoperative pain management. Follow-up is required during all stages of recovery to assess adverse events. Patients are usually discharged before PNB effects have worn off, but next-day follow-up allows the detection of adverse events. Digital systems are used for different follow-up services, but knowledge is lacking in their use for PNB follow-up. Objective: This narrative review describes PNB-related adverse events and current ambulatory surgery follow-up practices during all recovery stages. Furthermore, this review will evaluate the methods used for PNB follow-up. Methods: A literature search was performed using SCOPUS, Embase, and MEDLINE databases from the earliest record to 01-03-2022. Articles were included if they assessed PNB-related adverse events, follow-up services for ambulatory surgery and PNBs, and outcomes for ambulatory surgery and PNBs. Articles were excluded if they studied non-surgical patients, were inaccessible or contained comments or letters. Results: 67 articles were included after screening. Three postoperative phases are described. Phase 1 encompasses the post-anesthetic care unit (PACU) stay. Phase 2 covers the time from PACU discharge to hospital discharge, and phase 3 starts after hospital discharge. The review shows that follow-up is provided adequately during the postoperative phases 1 and 2, but phase 3 lacks a proper follow-up. Possible complications for PNBs include pain, nausea and vomiting, dyspnea, neurological damage, and infection should be routinely evaluated postoperatively, preferably the day after discharge. Postoperative follow-up is often provided using a telephone call, but a lost-to-follow-up rate of up to 50% is described. Follow-up rates can be improved using digital follow-up systems, including automatic text messages and applications. Video consultations can be used to evaluate these complications. Conclusion: PNB postoperative follow-up after discharge is not well-provided. Telephone follow-up of PNB has a poor response. Digital follow-up systems, like automatic text messages and applications, can increase follow-up rates. Therefore, we recommend application-based follow-up systems. However, additional studies should evaluate the effect on patient outcomes.

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“…A clear definition of rebound pain is still missing. Some authors like Barry, Hamilton and others propose a definition via an increase in pain from NRS <3 to NRS >7, 2,3 while Dada et al define the phenomenon by the time and interval, in which the pain occurs 4 . Yet, most authors that reported rebound pain in the past have not given a definition other than severe pain or a quantifiable increase in pain associated with fading of the block 5–7 .…”

Section: Introductionmentioning

confidence: 99%

Rebound pain and postoperative pain profile following brachial plexus block compared to general anaesthesia—An observational study

Schubert,

Wiesmann,

Volberg

et al. 2023

Acta Anaesthesiol Scand

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BackgroundRegional anaesthesia has the benefit of reducing the need for systemic analgesia and therefore, potentially reducing undesired side effects. With the end of the sensory nerve block however, many patients report severe pain that requires therapy with opioids and often compromise the initial opioid sparing effect. This study aimed to characterise the postoperative pain profile and the phenomenon of rebound pain after axillary brachial plexus anaesthesia (RA) compared to general anaesthesia (GA).DesignSingle‐centre observational, stratified cohort study.SettingThe study was conducted at University Hospital Marburg from May 2020 until September 2022.ParticipantsOne hundred thirty‐two patients receiving elective hand and forearm surgery were enrolled in this study.InterventionsGroup RA received ultrasound‐guided brachial plexus anaesthesia via the axillary approach with 30 mL of prilocaine 1% and 10 mL ropivacaine 0.2%. Group GA received balanced or total intravenous general anaesthesia.Main Outcome MeasuresPrimary endpoint were integrated pain scores (IPS) within 24 h postoperatively. Secondary endpoints were pain scores (NRS 0–10), morphine equivalents, patient satisfaction, quality of recovery and opioid‐related side effects.ResultsOne hundred thirty‐two patients were analysed of which 66 patients received brachial plexus block and 66 patients received general anaesthesia. Following RA significantly lower IPS were seen directly after surgery (p < .001) and during the post‐anaesthesia care unit interval (p < .001) but equalised after 3 h at the ward. No overshoot in pain scores or increased opioid consumption could be detected. Patient satisfaction and postoperative recovery were comparable between both groups.ConclusionThe IPS and NRS was initially lower in the RA group, increased with fading of the block until equal to the GA group and equal thereafter. Although various definitions of rebound pain were met during this phase, the opioid sparing effect of regional anaesthesia was not counteracted by it. The incidence of episodes with uncontrolled, severe pain did not differ between groups. We found no clinical implications of rebound pain in this setting, since the RA group did not show higher pain scores than the GA group at any time point.Trial Registration: German Clinical Trials Register (DRKS00021764).

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Rebound pain: distinct pain phenomenon or nonentity?

Cited by 14 publications

References 28 publications

Effects of esketamine on postoperative rebound pain in patients undergoing unilateral total knee arthroplasty: a single-center, randomized, double-blind, placebo-controlled trial protocol

Effects of esketamine on postoperative rebound pain in patients undergoing unilateral total knee arthroplasty: a single-center, randomized, double-blind, placebo-controlled trial protocol

Safety and follow-up systems after ambulatory peripheral nerve block: a narrative review

Rebound pain and postoperative pain profile following brachial plexus block compared to general anaesthesia—An observational study

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