Admassie Belete Muluadam, Tegegne Biresaw Ayen, Alemu Wudie Mekonnen, Getahun Amare Belete
Department of Anesthesia, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
Ann Med Surg (Lond). 2022 Nov 18;84:104915. doi: 10.1016/j.amsu.2022.104915. eCollection 2022 Dec.
Rebound pain is extreme pain that persists after the effects of regional anesthesia wear off. Rebound pain occurrence and intensity are influenced by patient, surgical, and anesthesia-related factors. The incidence and severity of rebound pain after peripheral nerve block resolution are both reduced by the use of perioperative multimodal strategy. The purpose of the current paper was to evaluate the frequency, seriousness, and risk factors for rebound pain following peripheral nerve block resolution.
A cross-sectional study centred on 384 patients who had received peripheral nerve blocks was carried out from August 20, 2021, to June 30, 2022. A semi-structured questionnaire was used to gather information within 24 h following the block's performance. SPSS 25 was used to enter and analyze the data. The change from well-controlled pain while the block is operating to severe pain within 24 h of block performance is known as rebound pain. Both univariate and multivariable analyses were used to examine the relationship between various parameters (patient, surgical, and anesthetic-related factors) and rebound pain. In the multivariable analysis, a P-value of 0.05 or lower is regarded as statistically significant.
The incidence of rebound pain after peripheral nerve block was resolved was 61.7% (95% CI: 56.5-66.7) with a mean rebound pain score of 4.19 ± 2. Of the total 237, 120(50.6%) had severe rebound pain after the peripheral nerve block was resolved. The use of preoperative intravenous dexamethasone (AOR: 2.6, 95%CI: 20.29-24.57), preoperative pain (AOR: 3.9, 95%CI: 41-57.4), type of surgery (AOR: 6.5, 95%CI: 1.45-11.7), post-operative NSAID (AOR: 2.2, 95%CI: 17.69-20.8), and opioid use (AOR: 2.2, 95%CI: 19.1-22.56) were independent risks associated with rebound pain.
and Recommendation: Rebound pain occurred in 61.7% of patients and had independent associations with preoperative pain, dexamethasone premedication, type of surgery, use of an adjuvant, use of postoperative opioids, and NSAIDs. Therefore, clinicians should continue to use preventative strategies, especially for patients at higher risk of experiencing rebound pain.
反弹痛是指区域麻醉效果消退后持续存在的剧痛。反弹痛的发生及强度受患者、手术及麻醉相关因素影响。围手术期多模式策略可降低外周神经阻滞后反弹痛的发生率及严重程度。本文旨在评估外周神经阻滞后反弹痛的发生频率、严重程度及危险因素。
2021年8月20日至2022年6月30日，对384例接受外周神经阻滞的患者进行了一项横断面研究。采用半结构化问卷在阻滞操作后24小时内收集信息。使用SPSS 25录入并分析数据。从阻滞操作时疼痛得到良好控制到阻滞操作后24小时内出现剧痛的变化称为反弹痛。采用单因素和多因素分析来研究各种参数（患者、手术及麻醉相关因素）与反弹痛之间的关系。在多因素分析中，P值小于或等于0.05被视为具有统计学意义。
外周神经阻滞后反弹痛的发生率为61.7%（95%置信区间：56.5 - 66.7），平均反弹痛评分为4.19±2。在总共237例患者中，120例（50.6%）在外周神经阻滞后出现严重反弹痛。术前静脉注射地塞米松（比值比：2.6，95%置信区间：20.29 - 24.57）、术前疼痛（比值比：3.9，95%置信区间：41 - 57.4）、手术类型（比值比：6.5，95%置信区间：1.45 - 11.7）、术后非甾体抗炎药（比值比：2.2，95%置信区间：17.69 - 20.8）及阿片类药物使用（比值比：2.2，95%置信区间：19.1 - 22.56）是与反弹痛相关的独立危险因素。
61.7%的患者出现了反弹痛，且其与术前疼痛、地塞米松预处理、手术类型、辅助用药、术后阿片类药物及非甾体抗炎药的使用存在独立关联。因此，临床医生应继续采用预防策略，尤其是对于有较高反弹痛风险的患者。
