The Phenomenon of Rebound Pain After Peripheral Nerve Block

Abstract

Peripheral nerve blocks provide highly effective postoperative analgesia for limb surgeries. But the complete resolution of the blockade is frequently followed by an abrupt and severe escalation in pain intensity that significantly exceeds baseline levels. This acute hyperalgesic response is termed ‘rebound pain’. Despite affecting nearly one half of all ambulatory orthopedic patients, standardized clinical protocols for its prevention remain unfound.

The paper focuses on the pathophysiological mechanisms, patient-specific demographics, surgical risk factors, and pharmacological management strategies regarding severe rebound pain following peripheral nerve blockade.

We investigated few studies focusing on the occurrence of rebound pain following peripheral nerve blocks for upper and lower limb surgeries. The debate included studies focusing particularly on pathophysiology, risk factors, and pharmacological adjuvants used, while central neuraxial techniques were excluded.

Rebound pain represents a distinct physiological state driven by the silent peripheral accumulation of inflammatory mediators, coupled with a central nervous system unprepared for sudden nociceptive input. Risk stratification identifies younger patients, females, and individuals undergoing major osseous procedures as highly susceptible. Regarding pharmacological intervention, prioritizing maximum block duration does not necessarily improve the patient's functional recovery. Although perineural dexamethasone demonstrates a statistically significant prolongation of sensory effects, it fails to improve postoperative sleep quality or reduce peak rebound pain severity when compared to systemic intravenous administration. Perineural particulate steroids also carry theoretical risks of neurotoxicity.

Mitigating the escalation of rebound pain requires shifting clinical focus away from maximizing sensory block duration toward optimizing the transitional analgesic phase. Current evidence supports the integration of preemptive, timed multimodal bridging analgesia combined with intravenous dexamethasone. Future research should prioritize functional patient outcomes, specifically sleep quality, over block duration