Frequency of rebound pain and related factors in a multimodal regimen including systemic dexamethasone and dexmedetomidine.

Abstract

Background: This prospective observational study aimed to explore the frequency and risk factors of rebound pain (RP) in patients treated with multimodal analgesia and intravenous dexamethasone following a peripheral nerve block (PNB).

Material and methods: All patients who received preoperative PNB were given a standard multimodal analgesia regimen and intravenous dexamethasone. Motor and sensory block durations, RP severity and frequency were measured for the first 24 h post-PNB using a semistructured questionnaire. The RP was identified as acute postoperative pain within the first 12-24 h after sensory blockade resolution. The severity of RP was determined through the rebound pain score. Contributing risk factors to the development of RP were investigated.

Results: After the PNB had worn off RP developed in 27.7%. The following were identified as independent risk factors for RP: patient age, with an adjusted odds ratio (AOR) of 2.3 and a 95% confidence interval (CI) of 1.4-3.9, the use of bupivacaine in combination with lidocaine or prilocaine (AOR: 2.1, 95% CI 1.2-3.8), preoperative pain (AOR: 2.8, 95% CI 1.3-5.6), bone surgery (AOR: 1.8, 95% CI 1.0-3.0) and the duration of the surgery (AOR: 2.8, 95% CI 1.5-5.1).

Conclusion: An exact identification of risk factors for RP can aid in creating preventative strategies that target changeable elements. A comprehensive understanding of this occurrence by PNB practitioners can lead to more effective use of PNB, decreased RP instances and improved outcome optimization.