Comparison of the efficacy of different interventions for rebound pain after brachial plexus block in upper extremity surgery: A systematic review and network meta-analysis
Authors' conclusion
In patients undergoing upper-extremity surgery with brachial plexus block, current network meta-analysis findings suggest that continuous nerve block is associated with a lower incidence of rebound pain and reduced pain scores at 12 and 24 h postoperatively, although further validation is still required.
Study context
- Population
- Patients undergoing upper extremity surgery with brachial plexus block
- Participants
- 1,699 patients · 22 randomised controlled trials (RCTs)
- Comparison
- Dexamethasone, esketamine, dexmedetomidine, liposomal bupivacaine, continuous nerve block and combined nerve block vs placebo
- Outcome
- Rebound pain incidence
Methodological detailsSUCRA ranking, Searched PubMed, Web of Science, Embase and Cochrane Library up to 10 October 2025
- SUCRA ranking
- Searched PubMed, Web of Science, Embase and Cochrane Library up to 10 October 2025
Pooled result
As reported in the abstract
Each group vs placeboOdds ratio (95% CI)
Dexamethasone
0.22(0.11–0.42)
Dexmedetomidine
0.23(0.08–0.68)
Continuous nerve block
0.04(0.01–0.33)
Further pooled results
| Outcome | MD (95% CI) | |
|---|---|---|
| 12-h postoperative pain scoresDexamethasone vs Placebo | −2.54 (−4.76 to −0.26) | |
| 12-h postoperative pain scoresContinuous nerve block vs Placebo | −3.10 (−5.86 to −0.23) | |
| 24-h postoperative pain scoresCombined nerve block vs Placebo | −0.86 (−1.59 to −0.13) | |
| −10−505Difference (linear scale) |
24-h postoperative pain scores
- SUCRA ranked continuous nerve block most favourable for 12-h/24-h pain scores
Original publication
Comparison of the efficacy of different interventions for rebound pain after brachial plexus block in upper extremity surgery: A systematic review and network meta-analysis. Eur J Anaesthesiol. Published 17 September 2026. doi:10.
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