A patient whose shoulder is numb and comfortable in recovery, discharged with no pain, is a patient who will be woken at two in the morning by the worst pain of the episode. Rebound pain after a single-shot interscalene block affects roughly two in five, and the distress it causes is largely about the surprise.
So the conversation belongs before the block. Tell them the arm will be numb for a set number of hours, that the pain will arrive as it wears off and may be severe, and that the way to avoid it is to take the oral analgesia before the block wears off rather than after. Give a specific time to start it, not 'when it hurts'.
Write the same instruction into the discharge letter, because the person who wakes at two is usually not the person who had the conversation in the anaesthetic room.
- Name rebound pain explicitly during consent, with an expected time of onset
- Instruct the patient to start regular oral analgesia before the block wears off
- Give a clock time, not a symptom trigger
- Put the instruction in writing on the discharge summary
- Include the family member who will be there overnight in the conversation
Why it matters
Most of the suffering from rebound pain comes from nobody having mentioned it.
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