Rebound pain after regional anesthesia in ambulatory surgery: a narrative review
Rebound pain, Nerve block, Regional anesthesia, Ambulatory surgery
Published online: May 17 2024
Abstract
Background: Rebound pain is a condition that may occur after regional anesthesia, characterized by an intense pain sensation exceeding the normal surgical pain. Despite being a research topic for the past decade, the underlying causes of this phenomenon still need to be clarified, and there are currently no clear recommendations on effective management.
Objective: This narrative review aims to provide a comprehensive understanding of rebound pain by presenting current research on its incidence, pathophysiology theories and risk factors and discussing management strategies in ambulatory surgery.
Methods: A literature research was performed between January 09, 2023, and February 27, 2023, using EMBASE, MEDLINE and Web of Science. We included all records concerning rebound pain in an ambulatory setting published in the last five years, and their findings were summarized.
Results: Rebound pain incidence is estimated at 50% after regional anesthesia. The currently more accepted consensus on the etiology behind rebound pain is the uncovering of unopposed nociceptive stimuli as the peripheral nerve block starts to fade. Primary risk factors include female gender, younger age, bone surgery, open surgical access, and pain catastrophizing. Dexamethasone and dexmedetomidine combined improve postoperative analgesia and extends sensory but not motor block. Early implementation of multimodal analgesia and comprehensive patient education are key features in management. Implementing patient education through verbal and written instructions concerning the expected trajectory and analgesics improves therapy compliance and reduces anxiety and uncertainty.
Conclusions: The currently more accepted consensus on the etiology behind rebound pain is the uncovering of unopposed nociceptive stimuli upon block resolution. Dexamethasone and dexmedetomidine combined improve postoperative analgesia and extends sensory but not motor block. Early implementation of multimodal analgesia is key in rebound pain prevention. Extensive patient education and verifying their expectations should be integral parts of the preoperative assessment in regional anesthesia.
