Prophylactic interventions to prevent rebound pain after peripheral nerve block in adults: a systematic review and network meta‐analysis of randomised controlled trials

Rebound pain after peripheral nerve block is increasingly recognized as a postoperative complication that can reduce the benefits of regional anesthesia. A systematic review and network meta-analysis included 24 randomized controlled trials with 2130 patients and eight intervention strategies. Intravenous dexamethasone had the highest probability of reducing rebound pain incidence and was rated as definitely superior to control. Perineural dexamethasone and perineural dexmedetomidine were most effective in delaying rebound pain and prolonging time to first rescue analgesia. Pre-emptive opioids were probably inferior to control. The certainty of evidence ranged from very low to moderate. Patient satisfaction and pain severity were reported inconsistently. Intravenous dexamethasone appears to be the most effective first-line option for preventing rebound pain after peripheral nerve blocks.