Factors associated with rebound pain after peripheral nerve block for ambulatory surgery

Garrett S. Barry, Jonathan G. Bailey, Joel Sardinha, Paul Brousseau, Vishal Uppal

Research output: Contribution to journalArticlepeer-review

117 Citations (Scopus)

Abstract

Background: Rebound pain is a common, yet under-recognised acute increase in pain severity after a peripheral nerve block (PNB) has receded, typically manifesting within 24 h after the block was performed. This retrospective cohort study investigated the incidence and factors associated with rebound pain in patients who received a PNB for ambulatory surgery. Methods: Ambulatory surgery patients who received a preoperative PNB between March 2017 and February 2019 were included. Rebound pain was defined as the transition from well-controlled pain (numerical rating scale [NRS] ≤3) while the block is working to severe pain (NRS ≥7) within 24 h of block performance. Patient, surgical, and anaesthetic factors were analysed for association with rebound pain by univariate, multivariable, and machine learning methods. Results: Four hundred and eighty-two (49.6%) of 972 included patients experienced rebound pain as per the definition. Multivariable analysis showed that the factors independently associated with rebound pain were younger age (odds ratio [OR] 0.98; 95% confidence interval [CI] 0.97–0.99), female gender (OR 1.52 [1.15–2.02]), surgery involving bone (OR 1.82 [1.38–2.40]), and absence of perioperative i.v. dexamethasone (OR 1.78 [1.12–2.83]). Despite a high incidence of rebound pain, there were high rates of patient satisfaction (83.2%) and return to daily activities (96.5%). Conclusions: Rebound pain occurred in half of the patients and showed independent associations with age, female gender, bone surgery, and absence of intraoperative use of i.v. dexamethasone. Until further research is available, clinicians should continue to use preventative strategies, especially for patients at higher risk of experiencing rebound pain.

Original languageEnglish
Pages (from-to)862-871
Number of pages10
JournalBritish Journal of Anaesthesia
Volume126
Issue number4
DOIs
Publication statusPublished - Apr 2021

Bibliographical note

Funding Information:
Nova Scotia Health Authority Resident Research Fund (Award number 1024065; $4893); Department of Anesthesia, internal fund ($4953, awarded but not disbursed because of other funding sources).

Publisher Copyright:
© 2020 The Authors

ASJC Scopus Subject Areas

  • Anesthesiology and Pain Medicine

PubMed: MeSH publication types

  • Journal Article

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