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Rebound pain after regional anesthesia in the ambulatory patient

Lavand’homme, Patricia

Current Opinion in Anesthesiology: December 2018 - Volume 31 - Issue 6 - p 679–684
doi: 10.1097/ACO.0000000000000651
AMBULATORY ANESTHESIA: Edited by Claude Meistelman

Purpose of review Regional anesthesia is popular in ambulatory setting allowing safe and fast recovery. The problem of ‘rebound pain’, that is very severe pain when peripheral nerve block (PNB) wears off represents a clinically relevant problem and a cause of increased healthcare resource utilization. This review tries to make the point on a not so rare, unwanted and often neglected side effect of PNB.

Recent findings The major finding is the lack of large prospective studies. Incidence of rebound pain is unknown but could reach 40% of patients at PNB resolution. To date, pathophysiological mechanisms remain debated: mechanical and chemical (proinflammatory effect of local anesthetics) nerve insult caused by PNB in predisposed patients (with severe preoperative pain, younger patients). Effective preventive strategies also are missing (e.g. role of analgesic adjuvants in PNB). Long-term consequences in term of functional recovery and persistent pain have not been demonstrated. Interview of patients has underlined the need of information and education about PNB and postoperative analgesia.

Summary Patients’ report of excruciating pain and major distress when PNB wears off questions the quality of current anesthesia practice in ambulatory setting. Rebound pain unanswered questions are challenging in the area of perioperative medicine.

Department of Anesthesiology, Cliniques Universitaires St Luc – University Catholic of Louvain, Brussels, Belgium

Correspondence to Patricia Lavand’homme, MD, PhD, Department of Anesthesiology, Cliniques Universitaires St Luc – University Catholic of Louvain, Av Hippocrate 10, B-1200, Brussels, Belgium. Tel: +32 2 764 18 21; fax: +32 2 764 36 99; e-mail: patricia.lavandhomme@uclouvain.be

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