Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA; Department of Anesthesiology, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA.
Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
Anesthesiol Clin. 2022 Sep;40(3):445-454. doi: 10.1016/j.anclin.2022.03.002. Epub 2022 Aug 2.
Patients who have perioperatively benefited from regional anesthesia frequently report moderate to severe pain when the nerve block effects fade away. Over the past years, the term "rebound pain" has been introduced, suggesting a specific pathologic process. It is debated whether significant pain on block resolution reflects a separate and distinct pathologic mechanism potentially involving proinflammatory and neurotoxic effects of local anesthetics, or is simply caused by the recovery of sensory function at a timepoint when nociceptive stimuli are still intense, and moderate to severe pain should be anticipated. In that latter case, the phenomenon referred to as rebound pain could be considered a failure of pain management providers to devise an adequate analgesia plan. Whatever the ultimate designation, management of rebound pain should be proactive, by implementing multimodal analgesia, or tailoring the blockade to the expected trajectory of postoperative pain and managing patient expectations accordingly. Until we know more about the etiology and impact of this phenomenon, the authors suggest a more neutral designation such as "pain on block resolution."
术后受益于区域麻醉的患者在神经阻滞作用消退时常报告中至重度疼痛。在过去的几年中，“反弹痛”一词已经被引入，提示存在特定的病理过程。目前仍存在争议，即阻滞解除时的明显疼痛是否反映了一种独立且不同的病理机制，可能涉及局部麻醉剂的促炎和神经毒性作用，或者仅仅是由于在伤害性刺激仍然强烈且中至重度疼痛可预见的时刻感觉功能恢复所致。在后一种情况下，所谓的反弹痛现象可能被认为是疼痛管理提供者未能制定出足够的镇痛计划的失败。无论最终的名称如何，反弹痛的管理都应该是积极主动的，通过实施多模式镇痛，或者根据术后疼痛的预期轨迹调整阻滞，并相应地管理患者的期望。在我们了解更多关于这种现象的病因和影响之前，作者建议使用更中立的名称，如“阻滞解除时的疼痛”。
