Abstract
Regional anesthesia has been considered a great tool for maximizing post-operative pain control while minimizing opioid consumption. Post-operative rebound pain, characterized by hyperalgesia after the peripheral nerve block, can however diminish or negate the overall benefit of this modality due to a counter-productive increase in opioid consumption once the block wears off. We reviewed published literature describing pathophysiology and occurrence of rebound pain after peripheral nerve blocks in patients undergoing orthopedic procedures. A search of relevant keywords was performed using PubMed, EMBASE, and Web of Science. Twenty-eight articles (n = 28) were included in our review. Perioperative considerations for peripheral nerve blocks and other alternatives used for postoperative pain management in patients undergoing orthopedic surgeries were discussed. Multimodal strategies including preemptive analgesia before the block wears off, intra-articular or intravenous anti-inflammatory medications, and use of adjuvants in nerve block solutions may reduce the burden of rebound pain. Additionally, patient education regarding the possibility of rebound pain is paramount to ensure appropriate use of prescribed pre-emptive analgesics and establish appropriate expectations of minimized opioid requirements. Understanding the impact of rebound pain and strategies to prevent it is integral to effective utilization of regional anesthesia to reduce negative consequences associated with long-term opioid consumption.
Highlights
IntroductionWhile regional anesthesia is considered a great tool for reducing postoperative pain and opioid consumption, rebound pain following nerve blocks may reduce or even negate its overall benefits.Rebound pain is a condition characterized by hyperalgesia after the peripheral nerve block wears off.While patients experience less pain and lower opioid consumption when the peripheral nerve block is functioning, the occurrence of rebound pain often leads to a counter-productive increase in opioid consumption thereafter.Postoperative pain is one of the most feared surgical complications reported by patients, for orthopedic surgeries, which are frequently followed by a painful recovery [1,2,3].Among strategies to prevent acute pain from progressing to chronic pain, opioid-based therapy has become a mainstay of intraoperative and postoperative pain management [4,5,6]
We reviewed published literature describing the pathophysiology of rebound pain and reporting its occurrence after peripheral nerve blocks for orthopedic procedures
Rebound pain after peripheral nerve blocks for orthopedic surgeries may reduce the overall benefits of regional anesthesia
Summary
While regional anesthesia is considered a great tool for reducing postoperative pain and opioid consumption, rebound pain following nerve blocks may reduce or even negate its overall benefits.Rebound pain is a condition characterized by hyperalgesia after the peripheral nerve block wears off.While patients experience less pain and lower opioid consumption when the peripheral nerve block is functioning, the occurrence of rebound pain often leads to a counter-productive increase in opioid consumption thereafter.Postoperative pain is one of the most feared surgical complications reported by patients, for orthopedic surgeries, which are frequently followed by a painful recovery [1,2,3].Among strategies to prevent acute pain from progressing to chronic pain, opioid-based therapy has become a mainstay of intraoperative and postoperative pain management [4,5,6]. While regional anesthesia is considered a great tool for reducing postoperative pain and opioid consumption, rebound pain following nerve blocks may reduce or even negate its overall benefits. Rebound pain is a condition characterized by hyperalgesia after the peripheral nerve block wears off. While patients experience less pain and lower opioid consumption when the peripheral nerve block is functioning, the occurrence of rebound pain often leads to a counter-productive increase in opioid consumption thereafter. Among strategies to prevent acute pain from progressing to chronic pain, opioid-based therapy has become a mainstay of intraoperative and postoperative pain management [4,5,6]. In spite of their efficacy in the management of acute and chronic pain, opioids are strongly associated with unwanted effects [7]. Opioids are the leading cause of drug overdose deaths and for
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