The through-line of today's regional-anaesthesia evidence is timing. Rebound pain after a single-shot block is predictable, so manage it before it happens: give intravenous dexamethasone as prophylaxis, choose a perineural adjunct when you want to prolong the block, and set the patient's expectation that the block will wear off and their oral analgesia must be taken before it does. The worst outcome — a distressed patient at 3 am whose block has failed and whose regular analgesia was never started — is an anaesthetic-room decision, not a ward one.
- Give IV dexamethasone at the time of a single-shot block to pre-empt rebound pain
- Add a perineural adjunct when the goal is to prolong the block
- Tell the patient the block will wear off and to take oral analgesia before it does
- Start regular multimodal analgesia before the block regresses, not after
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