Department of Anesthesiology and Pain Medicine, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.
Department of Anesthesia and Perioperative Medicine, University Hospital, London Health Sciences Center, Western University, London, ON, Canada.
Korean J Anesthesiol. 2020 Oct;73(5):372-383. doi: 10.4097/kja.20436. Epub 2020 Aug 10.
Rebound pain after regional anesthesia can be defined as transient acute postoperative pain that ensues following resolution of sensory blockade, and is clinically significant, either with regard to the intensity of pain or the impact on psychological well-being, quality of recovery, and activities of daily living. Current evidence suggests that it represents an unmasking of the expected nociceptive response in the absence of adequate systemic analgesia, rather than an exaggerated hyperalgesic phenomenon induced by local anesthetic neural blockade. In the majority of patients, it does not appear to significantly impact cumulative postoperative opioid consumption, quality of recovery, or patient satisfaction, and is not associated with longer-term sequelae such as persistent post-surgical pain. Nevertheless, it must be considered whenever regional anesthesia is incorporated into perioperative management. Strategies to mitigate the impact of rebound pain include routine prescribing of a systemic multimodal analgesic regimen, as well as patient education on appropriate expectations regarding block offset and expected surgical pain, and timely initiation of analgesic medication. Prolonging the duration of action of regional anesthesia with continuous catheter techniques or local anesthetic adjuncts may also help alleviate rebound pain, although further research is required to confirm this.
区域麻醉后反弹痛可定义为感觉阻滞消退后出现的短暂急性术后疼痛,其具有临床意义,无论是疼痛强度还是对心理幸福感、恢复质量和日常生活活动的影响。目前的证据表明,这代表了在没有足够全身镇痛的情况下预期伤害性反应的显现,而不是局部麻醉神经阻滞引起的过度痛觉过敏现象。在大多数患者中,它似乎不会显著影响累积术后阿片类药物消耗、恢复质量或患者满意度,也与长期后遗症(如持续性术后疼痛)无关。然而,只要将区域麻醉纳入围手术期管理,就必须考虑到这一点。减轻反弹痛影响的策略包括常规开具系统多模式镇痛方案,以及对阻滞消退和预期手术疼痛的适当预期进行患者教育,并及时开始使用镇痛药。通过连续导管技术或局部麻醉辅助剂延长区域麻醉的作用持续时间也可能有助于缓解反弹痛,但需要进一步研究来证实这一点。