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TOPLINE:

A network meta-analysis found that intravenous (IV) dexamethasone ranked highest in the probability of reducing the incidence of rebound pain after peripheral nerve blocks in adults who underwent surgery, whereas perineural dexmedetomidine was most likely to delay its onset.

METHODOLOGY:

• Researchers conducted a systematic review and network meta-analysis of randomized controlled trials to compare interventions for preventing rebound pain after peripheral nerve blocks.
• They searched four major databases through April 2025 for trials involving adults who underwent surgery with peripheral nerve blocks and also screened for reference lists of included trials, prior systematic reviews, meta-analyses, and clinical guidelines.
• Both IV and perineural strategies were evaluated, including dexamethasone, dexmedetomidine, ketamine, esketamine, preemptive opioids, and perineural catheters.
• The primary outcome was the incidence of rebound pain. Treatments were ranked using surface under the cumulative ranking curve (SUCRA) scores, with higher scores indicating a greater likelihood of reducing the occurrence of rebound pain.
• The risk for bias and quality of the included studies was assessed using relevant tools.

TAKEAWAY:

• The analysis included 24 trials involving 2130 adults. Of these, 17 trials were rated as having a low risk for bias, five had some concerns, and two were at a high risk, and the certainty of evidence ranged from very low to moderate.
• IV dexamethasone had the highest SUCRA score (0.91) and was ranked most likely to reduce the incidence of rebound pain (20 studies). The approach was judged as definitely superior to control.
• Perineural dexmedetomidine had the highest probability of delaying the onset of rebound pain (SUCRA score, 0.76; 10 studies), whereas perineural dexamethasone had the highest probability of prolonging the time to first rescue analgesia (SUCRA score, 0.84; eight studies).
• Preemptive opioids appeared probably inferior to control regarding the incidence of rebound pain. However, this finding was based on direct evidence from a single trial.

IN PRACTICE:

The meta-analysis “highlights intravenous dexamethasone as having the highest probability of reducing the burden of rebound pain following single-injection peripheral nerve blocks,” the researchers reported. “Other drugs, such as perineural dexamethasone and dexmedetomidine, showed potential benefits and may represent viable alternatives or adjuncts in clinical practice.”

SOURCE:

The study was led by Narinder Pal Singh, University of Ottawa, Ottawa, Ontario, Canada. It was published online on May 26 in Anaesthesia.

LIMITATIONS:

The trials had substantial variability in block techniques, local anesthetics, surgeries, and definitions of rebound pain. One trial comparing a continuous catheter with IV dexmedetomidine could not be included. Several drugs were evaluated in only a few trials.

DISCLOSURES:

The authors did not declare any external funding or competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.