Prevention and management of rebound pain after resolution of regional block: a systematic review

Abstract

Background: An extreme pain known as rebound pain develops after regional blockage wears off. Patient, surgical, and anesthesia-related factors influence the occurrence and intensity of rebound pain. Prior to the peripheral nerve block (PNB) being resolved, multimodal therapy should use. The objective of this review was to explore rebound pain prevention and management following PNB resolution. Methods: We conducted a thorough search across Pub Med, Hinari, Google Scholar, and Cochrane review databases, utilizing relevant keywords and search parameters to identify studies meeting our inclusion criteria. These studies aimed to provide sufficient evidence regarding the prevention and management of rebound pain following the resolution of regional blocks. Duplicate entries were removed using Endnote software. Screening of the literature was performed using a rigorous appraisal checklist. The findings of this review are reported in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement. Results: Using an electronic search, 3526 items were found from databases and websites. After removing duplicates (n=500), 3026 articles remained. Of these, 2813 were excluded after going through their titles and abstracts. Of the 213 articles screened, 126 were removed for such reasons as ineligibility or similarity in objectives. Of the remaining 87 studies, 37 were excluded for such reasons as the inaccessibility of free full texts. Finally, 50 studies were included for review. Conclusions and recommendation: Proper patient education about rebound pain, combined with the utilization of multimodal systemic analgesia before the resolution of PNBs, perineural dexamethasone, and employing a combination of nerve blocks, has been demonstrated to decrease the incidence of rebound pain. Therefore, clinicians should aim to prevent and manage rebound pain by implementing perioperative multimodal strategies before the resolution of regional blocks.