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Effect of Adding Esketamine to Patient-Controlled Intravenous Analgesia on Rebound Pain After Interscalene Brachial Plexus Block: A Randomized Controlled Trial

Year: 2026

Type: article

Study designs: Randomized Controlled Trial, Clinical Trial

Abstract: Background: Rebound pain after peripheral nerve block (PNB) may diminish the analgesic benefits of regional anesthesia. Whether esketamine administered via postoperative patient-controlled intravenous analgesia (PCIA) can prevent rebound pain remains unclear. This study aimed to evaluate the effect of esketamine-containing PCIA on rebound pain after interscalene brachial plexus block in patients undergoing shoulder arthroscopic surgery. Methods: 132 patients scheduled for arthroscopic shoulder surgery under general anesthesia combined with interscalene brachial plexus block were randomized 1:1 to receive postoperative PCIA with esketamine (1.25 mg/kg) plus sufentanil (100 μg) and flurbiprofen axetil (100 mg) (ES group, n=66) or sufentanil plus flurbiprofen axetil alone (Control group, n=66). The primary outcome was rebound pain, defined as an increase from well-controlled pain (NRS ≤ 3) to severe pain (NRS ≥ 7), typically after resolution of the nerve block. Secondary outcomes included time to rebound pain, modified pain score, rebound pain duration, analgesic consumption, numerical rating scale (NRS) at 6, 12, 24, and 48 h postoperatively, Quality of Recovery-15 (QoR-15), Richards-Campbell Sleep Questionnaire (RCSQ) sleep quality, and adverse events. Results: The incidence of rebound pain did not differ significantly between groups (25.8% vs 39.4%; OR, 0.53; 95% CI, 0.39 to 1.09; P =0.095). Among patients who developed rebound pain, the ES group had a lower modified rebound pain score and shorter pain duration. For other secondary outcomes, patients receiving esketamine had lower NRS pain scores at 12, 24, and 48 h, fewer PCIA demands, less rescue analgesic use, and higher QoR-15 and RCSQ scores (all P < 0.05). The incidence of the assessed adverse events did not differ significantly between groups. Conclusion: Adding esketamine to postoperative PCIA did not demonstrate a reduction in rebound pain incidence after interscalene brachial plexus block. Exploratory subgroup findings suggested lower rebound pain intensity and duration, while improvements in postoperative analgesia, sleep, and recovery had uncertain clinical relevance. Further multicenter studies are needed to confirm these findings and to evaluate different dosing strategies and routes of administration. Keywords: Esketamine, rebound pain, peripheral nerve block, patient-controlled intravenous analgesia, shoulder arthroscopy

Source: Drug Design Development and Therapy

DOI: 10.2147/dddt.s644676

Authors: Ruipeng Zhong, Lanhua Zhong, Hua Zhu, Rong Huang, Weidong Liang, Yun Zou

Institutions: Ganzhou People's Hospital, First Affiliated Hospital of Gannan Medical University

Language: English

Topic: Anesthesia and Pain Management

Subfield: Anesthesiology and Pain Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $2,836