Rebound pain after a single-shot peripheral nerve block tends to arrive at night, several hours after discharge, when the block resolves and the patient has taken nothing. Much of it is preventable with scheduled rather than as-needed oral analgesia started before the block is expected to end.
Tell patients roughly when the block will wear off, to take their first regular doses before then, and what to do if pain breaks through.
- Tell patients the expected duration of their block before discharge.
- Prescribe scheduled paracetamol and an NSAID, if not contraindicated, starting before the block ends.
- Give clear breakthrough analgesia instructions for the first night.
- Warn that the limb may stay numb or weak and needs protecting until sensation returns.
Why it matters
Poorly managed rebound pain undoes much of the goodwill a good block earns.
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