Lavand'homme Patricia
Department of Anesthesiology, Cliniques Universitaires St Luc - University Catholic of Louvain, Brussels, Belgium.
Curr Opin Anaesthesiol. 2018 Dec;31(6):679-684. doi: 10.1097/ACO.0000000000000651.
Regional anesthesia is popular in ambulatory setting allowing safe and fast recovery. The problem of 'rebound pain', that is very severe pain when peripheral nerve block (PNB) wears off represents a clinically relevant problem and a cause of increased healthcare resource utilization. This review tries to make the point on a not so rare, unwanted and often neglected side effect of PNB.
The major finding is the lack of large prospective studies. Incidence of rebound pain is unknown but could reach 40% of patients at PNB resolution. To date, pathophysiological mechanisms remain debated: mechanical and chemical (proinflammatory effect of local anesthetics) nerve insult caused by PNB in predisposed patients (with severe preoperative pain, younger patients). Effective preventive strategies also are missing (e.g. role of analgesic adjuvants in PNB). Long-term consequences in term of functional recovery and persistent pain have not been demonstrated. Interview of patients has underlined the need of information and education about PNB and postoperative analgesia.
Patients' report of excruciating pain and major distress when PNB wears off questions the quality of current anesthesia practice in ambulatory setting. Rebound pain unanswered questions are challenging in the area of perioperative medicine.
区域麻醉在门诊环境中很受欢迎，可实现安全且快速的恢复。“反弹痛”问题，即外周神经阻滞（PNB）消退时出现的非常严重的疼痛，是一个临床相关问题，也是医疗资源利用增加的一个原因。本综述旨在探讨PNB一种并非罕见、不良且常被忽视的副作用。
主要发现是缺乏大型前瞻性研究。反弹痛的发生率尚不清楚，但在PNB消退时可能达到40%的患者。迄今为止，病理生理机制仍存在争议：在易感患者（术前疼痛严重、年轻患者）中，PNB引起的机械性和化学性（局部麻醉药的促炎作用）神经损伤。有效的预防策略也缺失（例如镇痛佐剂在PNB中的作用）。在功能恢复和持续性疼痛方面的长期后果尚未得到证实。对患者的访谈强调了关于PNB和术后镇痛的信息及教育的必要性。
患者报告PNB消退时极度疼痛和严重不适，这对当前门诊麻醉实践的质量提出了质疑。反弹痛的未解决问题在围手术期医学领域具有挑战性。
