- Design
- Systematic review and network meta-analysis of randomised trials
- Population
- 24 trials, 2,130 adults with single-injection peripheral nerve blocks
- Primary outcome
- Incidence of rebound pain
- Effect
- IV dexamethasone ranked best (SUCRA 0.91), judged definitely superior to control; pre-emptive opioids probably inferior
This network meta-analysis combined 24 randomised trials involving 2,130 adults who had surgery under single-injection peripheral nerve blocks, comparing eight drug strategies against control for the incidence of rebound pain.
Of the eight strategies, IV dexamethasone ranked first for lowering the incidence of rebound pain (SUCRA 0.91) and was rated definitely superior to control. Perineural dexamethasone and perineural dexmedetomidine did most to postpone rebound pain and the first need for rescue analgesia. Pre-emptive opioids probably performed worse than control. Data on severity, satisfaction and sleep could not be pooled.
Certainty ranged from very low to moderate, and rankings in network meta-analyses can overstate differences between close options. Doses varied across trials, and the evidence does not settle the best dose. Dexamethasone raises blood glucose, which matters for the many patients with diabetes in Indian surgical practice. Still, IV dexamethasone is cheap, widely used for nausea prophylaxis already, and here has the most consistent evidence for this specific problem. It was published in May 2026.
- Consider intravenous dexamethasone with a single-shot nerve block to reduce rebound pain.
- Check glucose in patients with diabetes, as dexamethasone raises it.
- Perineural dexamethasone or dexmedetomidine mainly delays the rebound rather than preventing it.
- Avoid relying on pre-emptive opioids to prevent rebound pain; they were probably worse than control.
- Combine drug prophylaxis with scheduled oral analgesia and patient education.
Why it matters
Rebound pain is the most common reason patients remember a block badly, and a cheap drug reduced it.
Don't overread it
Certainty was very low to moderate and the best dose is not established.
The statistics, in plain English
SUCRA (surface under the cumulative ranking curve) of 0.91 means IV dexamethasone ranked near the top in most simulations; it is a ranking, not an effect size. Network meta-analyses compare treatments indirectly through shared comparators, which is useful but weaker than head-to-head trials.
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