Factors Associated with Rebound Pain After Patient-controlled Epidural Analgesia in Patients Undergoing Major Abdominal Surgery: A Retrospective Study

Risk Factors for the Occurrence of Rebound Pain After Intercostal Nerves Block in Three-Port Thoracoscopic Surgery: A Case-Control Study

Background and Objectives

Rebound pain (RP), characterised by an acute increase in pain levels, is usually observed after the effects of block anaesthesia have subsided. Severe RP can cause adverse effects, thus affecting patient prognosis. In this study, we investigated the incidence of RP and its risk factors after intercostal nerve block in three-port thoracoscopic surgery to provide a clinical basis for identifying high-risk patients and providing early intervention.

Methods

A single-centre retrospective study was conducted on 475 patients who underwent three-hole thoracoscopic surgery from September 2022 to September 2023 in Jiaxing First Hospital. Data were collected and compared between patients who developed RP and those who did not. IBM SPSS Statistics 25.0 software was used for statistical analysis.

Results

Data were collected from 700 patients. After applying the exclusion criteria, 475 cases were finally included and the incidence of RP was 23.8%. The results showed that the differences in body mass index (BMI), upper and lower chest diameters, anterior and posterior chest diameters, left and right chest diameters, and gender between patients with RP and those without RP were statistically significant (p < 0.05). In addition, the proportion of female patients with RP was significantly higher. BMI (advantage ratio [OR] = 0.835, 95% confidence interval [CI]: 0.375 ~ 1.859), upper and lower chest diameters (OR = 0.916, 95% CI: 0.827 ~ 1.014), anterior and posterior chest diameters (OR = 0.765, 95% CI: 0.635 ~ 0.921), left and right chest diameters (OR = 0.612, 95% CI: 0.421 ~ 0.891), and gender (OR = 1.170, 95% CI: 0.576 ~ 2.373).

Conclusion

The incidence of RP after three-hole thoracoscopic intercostal nerve block is high and associated with multiple risk factors. Early intervention is needed for patients at risk of RP to improve patient prognosis and satisfaction.

[Peripheral Regional Anesthesia Techniques - Standards in Flux?!]

This review article provides an overview of current developments in peripheral regional anaesthesia (RA). The authors present a subjective compilation based on discussions at professional events and inquiries to the Working Group on Regional Anaesthesia of the German Society for Anaesthesiology and Intensive Care Medicine (DGAI). The article addresses several relevant topics, including the handling of antithrombotic medication in peripheral blockades with reference to European guidelines, the debate on the discharge timing after plexus anaesthesia, and the consideration of rebound pain as an independent pain entity following RA.Furthermore, the contentious discussion regarding the administration of peripheral nerve blockades under general anaesthesia is illuminated. The authors express no fundamental concerns in this regard but emphasize the importance of preoperative evaluation and individual patient needs. The question of mixing local anaesthetics is also addressed, with the authors critically questioning this tradition and recommending the use of individual, long-acting substances.Another focal point is the application of peripheral nerve blockades in emergency medicine, both in preclinical and emergency room settings. The authors highlight the necessity for high-quality studies and discuss the complex organizational issues associated with the preclinical application of RA techniques.