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Does Rebound Pain after Peripheral Nerve Block for Orthopedic Surgery Impact Postoperative Analgesia and Opioid Consumption? A Narrative Review

1
Department of Anesthesiology, The Ohio State University Wexner Medical Center, 520 Doan Hall, 410 West 10th Avenue, Columbus, OH 43210, USA
2
Department of Anesthesiology, Stony Brook University, Stony Brook, New York, NY 11794, USA
*
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2019, 16(18), 3257; https://doi.org/10.3390/ijerph16183257
Received: 24 July 2019 / Revised: 21 August 2019 / Accepted: 1 September 2019 / Published: 5 September 2019
(This article belongs to the Special Issue Effectiveness and Safety of High-Dose Opioid Therapy)
Regional anesthesia has been considered a great tool for maximizing post-operative pain control while minimizing opioid consumption. Post-operative rebound pain, characterized by hyperalgesia after the peripheral nerve block, can however diminish or negate the overall benefit of this modality due to a counter-productive increase in opioid consumption once the block wears off. We reviewed published literature describing pathophysiology and occurrence of rebound pain after peripheral nerve blocks in patients undergoing orthopedic procedures. A search of relevant keywords was performed using PubMed, EMBASE, and Web of Science. Twenty-eight articles (n = 28) were included in our review. Perioperative considerations for peripheral nerve blocks and other alternatives used for postoperative pain management in patients undergoing orthopedic surgeries were discussed. Multimodal strategies including preemptive analgesia before the block wears off, intra-articular or intravenous anti-inflammatory medications, and use of adjuvants in nerve block solutions may reduce the burden of rebound pain. Additionally, patient education regarding the possibility of rebound pain is paramount to ensure appropriate use of prescribed pre-emptive analgesics and establish appropriate expectations of minimized opioid requirements. Understanding the impact of rebound pain and strategies to prevent it is integral to effective utilization of regional anesthesia to reduce negative consequences associated with long-term opioid consumption. View Full-Text
Keywords: rebound pain; hyperalgesia; peripheral nerve blocks; orthopedic surgeries rebound pain; hyperalgesia; peripheral nerve blocks; orthopedic surgeries
MDPI and ACS Style

Dada, O.; Gonzalez Zacarias, A.; Ongaigui, C.; Echeverria-Villalobos, M.; Kushelev, M.; Bergese, S.D.; Moran, K. Does Rebound Pain after Peripheral Nerve Block for Orthopedic Surgery Impact Postoperative Analgesia and Opioid Consumption? A Narrative Review. Int. J. Environ. Res. Public Health 2019, 16, 3257. https://doi.org/10.3390/ijerph16183257

AMA Style

Dada O, Gonzalez Zacarias A, Ongaigui C, Echeverria-Villalobos M, Kushelev M, Bergese SD, Moran K. Does Rebound Pain after Peripheral Nerve Block for Orthopedic Surgery Impact Postoperative Analgesia and Opioid Consumption? A Narrative Review. International Journal of Environmental Research and Public Health. 2019; 16(18):3257. https://doi.org/10.3390/ijerph16183257

Chicago/Turabian Style

Dada, Olufunke; Gonzalez Zacarias, Alicia; Ongaigui, Corinna; Echeverria-Villalobos, Marco; Kushelev, Michael; Bergese, Sergio D.; Moran, Kenneth. 2019. "Does Rebound Pain after Peripheral Nerve Block for Orthopedic Surgery Impact Postoperative Analgesia and Opioid Consumption? A Narrative Review" Int. J. Environ. Res. Public Health 16, no. 18: 3257. https://doi.org/10.3390/ijerph16183257

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