Factors associated with a reduction in the preventive effect of intravenous dexamethasone on rebound pain after axillary brachial plexus block
Authors' conclusion
Preoperative nocturnal pain, severe anxiety, high catastrophising, and low salivary cortisol levels are factors that might reduce the efficacy of dexamethasone in preventing rebound pain.
Study context
- Population
- Patients undergoing ambulatory upper limb surgery with axillary brachial plexus block, given IV dexamethasone 0.1 mg kg-1 before surgery
- Participants
- 104 patients
- Outcome
- Rebound pain incidence (NRS >7)
- Follow-up
- Within the first 24 h
Main finding
As reported in the abstract
Rebound pain incidence
- Developed rebound pain
- 36 (34.6%)
- Preoperative nocturnal awakening pain, OR (P=0.03)
- 3.09
- Severe anxiety, OR (P=0.01)
- 3.54
- High catastrophising score, OR (P=0.01)
- 4.14
- Low salivary cortisol (<1147 pg ml-1), OR (P=0.02)
- 3.33
Observational data: associations, not effects.
Further findings
- Persistent pain at 3 months
- 27%
- Associated with postoperative rebound pain (P=0.04)
Original publication
Factors associated with a reduction in the preventive effect of intravenous dexamethasone on rebound pain after axillary brachial plexus block. Br J Anaesth. Published 22 July 2025. doi:10.
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