Authors

Belete Muluadam Admassie^1,2*, Adebusola Adenike Owokole^2,3,4,5

¹ Department of Anesthesia, College of Medicine and Health science, Bahir Dar University, Bahir Dar, Amhara, Ethiopia
² The Operating Room Global (TORG)
³ The Robotic Global Surgical Society (TROGSS)
⁴ UL Hospitals, Ireland
⁵ University of Limerick (UL), Ireland

Corresponding Author: Belete Muluadam Admassie · [email protected]

Study Summary

Background

Rebound pain is an underestimated postoperative complication characterized by severe pain after resolution of a peripheral nerve block. Although peripheral nerve blocks are increasingly used in orthopedic surgery, evidence regarding the incidence and predictors of rebound pain remains limited, particularly in low-resource settings.

Aim

To assess the incidence and predictors of rebound pain among adults undergoing upper-extremity orthopedic surgery under peripheral nerve block in Ethiopia during 2025/2026.

Methods

A prospective cohort study was conducted among 200 adult patients undergoing orthopedic surgery with peripheral nerve block. Participants were monitored for 48 hours after surgery. Data were collected using structured questionnaires and chart review, and pain intensity was measured with the Numeric Rating Scale following sensory block resolution. Multivariable logistic regression was used to identify independent predictors.

Results

Rebound pain occurred in 44.5% of the cohort. Dexamethasone premedication and intraoperative analgesia were independently associated with lower odds of rebound pain, while a neutrophil-to-lymphocyte ratio (NLR) ≥3 was independently associated with higher odds of rebound pain.

Conclusion

Rebound pain was common after peripheral nerve block for upper-extremity orthopedic surgery. The findings identify perioperative analgesia, dexamethasone premedication and elevated NLR as clinically relevant areas for further investigation and risk-informed perioperative pain management.

Keywords: Analgesia · Dexamethasone · incidence · Nerve block · Pain · Risk factors

Rebound Pain at a Glance

Adjusted Associations

Study Design & Analytical Approach

A prospective cohort study examining rebound pain following peripheral nerve block among adults undergoing upper-extremity orthopedic surgery at Tibebe Ghion Specialized Hospital in Ethiopia.

Implications & Limitations

The study supports further evaluation of multimodal transitional analgesia before peripheral nerve block resolution and highlights elevated NLR as a potential low-cost risk marker requiring validation in larger studies.

Article Details

Author Contributions

Belete Muluadam Admassie (BMA): Conceptualization, study design, data collection, analysis, interpretation and manuscript preparation.

Adebusola Adenike Owokole (AAO): Supervision, study design, interpretation and critical review.

Both authors approved the final manuscript.