Department of Anesthesia, Perioperative Medicine and Pain Management, Dalhousie University, Nova Scotia Health Authority and IWK Health Centre, Halifax, NS, Canada.
Department of Anesthesia, Perioperative Medicine and Pain Management, Dalhousie University, Nova Scotia Health Authority and IWK Health Centre, Halifax, NS, Canada; Department of Anesthesiology and Pain Management, University of Toronto, Toronto, ON, Canada.
Br J Anaesth. 2021 Apr;126(4):862-871. doi: 10.1016/j.bja.2020.10.035. Epub 2020 Dec 31.
Rebound pain is a common, yet under-recognised acute increase in pain severity after a peripheral nerve block (PNB) has receded, typically manifesting within 24 h after the block was performed. This retrospective cohort study investigated the incidence and factors associated with rebound pain in patients who received a PNB for ambulatory surgery.
Ambulatory surgery patients who received a preoperative PNB between March 2017 and February 2019 were included. Rebound pain was defined as the transition from well-controlled pain (numerical rating scale [NRS] ≤3) while the block is working to severe pain (NRS ≥7) within 24 h of block performance. Patient, surgical, and anaesthetic factors were analysed for association with rebound pain by univariate, multivariable, and machine learning methods.
Four hundred and eighty-two (49.6%) of 972 included patients experienced rebound pain as per the definition. Multivariable analysis showed that the factors independently associated with rebound pain were younger age (odds ratio [OR] 0.98; 95% confidence interval [CI] 0.97-0.99), female gender (OR 1.52 [1.15-2.02]), surgery involving bone (OR 1.82 [1.38-2.40]), and absence of perioperative i.v. dexamethasone (OR 1.78 [1.12-2.83]). Despite a high incidence of rebound pain, there were high rates of patient satisfaction (83.2%) and return to daily activities (96.5%).
Rebound pain occurred in half of the patients and showed independent associations with age, female gender, bone surgery, and absence of intraoperative use of i.v. dexamethasone. Until further research is available, clinicians should continue to use preventative strategies, especially for patients at higher risk of experiencing rebound pain.
反弹痛是一种常见但尚未被充分认识的外周神经阻滞（PNB）消退后急性疼痛加重现象，通常在阻滞后 24 小时内出现。本回顾性队列研究调查了接受门诊手术 PNB 的患者中反弹痛的发生率和相关因素。
纳入 2017 年 3 月至 2019 年 2 月期间接受术前 PNB 的门诊手术患者。反弹痛定义为阻滞起效时疼痛控制良好（数字评分量表 [NRS] ≤3）转为严重疼痛（NRS ≥7）的过程，发生在阻滞后 24 小时内。采用单变量、多变量和机器学习方法分析患者、手术和麻醉相关因素与反弹痛的关系。
根据上述定义，972 例纳入患者中有 482 例（49.6%）发生反弹痛。多变量分析显示，与反弹痛独立相关的因素是年龄较小（比值比 [OR] 0.98；95%置信区间 [CI] 0.97-0.99）、女性（OR 1.52 [1.15-2.02]）、涉及骨骼的手术（OR 1.82 [1.38-2.40]）和无围手术期静脉内用地塞米松（OR 1.78 [1.12-2.83]）。尽管反弹痛发生率较高，但患者满意度（83.2%）和恢复日常活动（96.5%）的比例较高。
反弹痛在一半的患者中发生，并与年龄、女性、骨骼手术和术中无静脉内用地塞米松的使用独立相关。在进一步的研究结果公布之前，临床医生应继续使用预防策略，特别是对有更高反弹痛风险的患者。
