Prevention of Rebound Pain After Orthopaedic Surgery With Peripheral Nerve Block (REBOUND)_part B

NCT07666009 | Not Yet Recruiting DMC

• 1 other identifier: 2026-00307_b
• Study Type: interventional
• Target: 100
• Locations: 1 country
• Sites: 1

Brief Summary

Rebound pain after peripheral nerve blocks reduces the benefits of regional anesthesia and increases opioid consumption. This rebound pain most likely results from suboptimal pain management, as patients receiving a peripheral nerve block are typically not given scheduled opioid doses. Oral Patient Controlled Analgesia (PCA) consists of an oral morphine prescription that allows patients to self-administer doses based on their pain score. This study will compare patients undergoing elective orthopaedic surgery under general anaesthesia or sedation with a peripheral nerve block, receiving oral morphine PCA either with or without additional scheduled oral morphine doses.

Conditions

Post Operative Analgesia; Rebound Pain; Post Operative Pain, Acute

Keywords

rebound pain; postoperative pain; pain management; orthopaedic surgery; peripheral nerve block

Outcome Measures

Primary Outcomes (1)

• Worst pain score during the first 24 hours after surgery

  Highest postoperative pain score during the first 24 hours after surgery, measured using a 0-10 Visual Analog Scale (VAS), where 0 indicates no pain and 10 indicates the worst pain imaginable

  24 hours postoperatively

Secondary Outcomes (14)

• Minimal pain score during the first 12 hours after surgery

  12 hours postoperatively

• Rebound pain score measured using the Visual Analog Scale (VAS)

  From surgery until 24 hours postoperatively

• Rest and dynamic pain scores

  At 2, 12, 24, 36, 48, 60, and 72 hours after surgery

• Incidence of severe pain

  From surgery through 3 months after surgery

• Persistence of pain

  During the follow-up period from discharge till 4 weeks and 3 months

Study Arms (2)

Scheduled group

EXPERIMENTAL

Oral morphine administered at predefined regular intervals starting immediately after surgery, with additional access to oral PCA.

Drug: Morphine provided via oral PCA + morphine administered at a scheduled regimen

On-demand group

ACTIVE COMPARATOR

Oral morphine administered on demand via PCA.

Drug: Morphine provided via oral PCA

Interventions

Morphine provided via oral PCA DRUG

Morphine will be administered according to a scheduled regimen (20mg slow release oral morphine at fixed 12-hour intervals), with additional oral PCA on demand for breakthrough pain (VAS \> 4), following the same bedside tablet procedure as in the control group. The maximum allowed dose through oral PCA will be 6 tablets (10mg each) per 24-hour period.

On-demand group

Morphine provided via oral PCA + morphine administered at a scheduled regimen DRUG

morphine will be administered according to a scheduled regimen (20mg slow-release oral morphine at fixed 12-hour intervals), with additional oral PCA on demand for breakthrough pain (VAS \> 4), following the same bedside tablet procedure as in the control group. The maximum allowed dose through oral PCA will be 6 tablets (10mg each) per 24-hour period.

Scheduled group

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Patients scheduled for elective orthopaedic surgery on the upper limb
• Patients scheduled for elective orthopaedic surgery on the lower limb.
• Score ASA I-III; Patients aged over 18 years; Signed informed consent.
• Surgery under general anaesthesia or under sedation

You may not qualify if:

• Refusal or inability to understand the informed consent
• Allergy to any of the following medications: ropivacaine, paracetamol, ibuprofen, ketorolac, morphine,sufentanil, ondansetron, or dexamethasone
• Patients with long term opioid treatment
• Bleeding diathesis
• Neurological disorders of the operated limb
• Known renal insufficiency (eGFR \<30 mL/min)
• Known hepatic insufficiency (Child-Pugh class B or C);
• Pregnant or breastfeeding women;
• Alcohol dependence syndrome;
• Patients under spinal anaesthesia;
• Patients undergoing amputation procedures

Sponsors & Collaborators

• Centre Hospitalier Universitaire Vaudois: lead

Study Sites (1)

CHUV, Centre Hospitalier Vaudois

Lausanne, Canton of Vaud, 1000, Switzerland

Location

Related Publications (16)

• Abdallah FW, Halpern SH, Aoyama K, Brull R. Will the Real Benefits of Single-Shot Interscalene Block Please Stand Up? A Systematic Review and Meta-Analysis. Anesth Analg. 2015 May;120(5):1114-1129. doi: 10.1213/ANE.0000000000000688.

  PMID: 25822923 BACKGROUND

• Wu CL, Badani S, Tedore TR. Peripheral nerve blocks for perioperative analgesia: das Kind mit dem Bade ausschutten...throwing the baby out with the bathwater? Br J Anaesth. 2025 Nov;135(5):1147-1150. doi: 10.1016/j.bja.2025.08.017. Epub 2025 Sep 22.

  PMID: 40987657 BACKGROUND

• Galos DK, Taormina DP, Crespo A, Ding DY, Sapienza A, Jain S, Tejwani NC. Does Brachial Plexus Blockade Result in Improved Pain Scores After Distal Radius Fracture Fixation? A Randomized Trial. Clin Orthop Relat Res. 2016 May;474(5):1247-54. doi: 10.1007/s11999-016-4735-1. Epub 2016 Feb 11.

  PMID: 26869374 BACKGROUND

• Makkar JK, Singh NP, Khurana BJK, Chawla JK, Singh PM. Efficacy of different routes of dexamethasone administration for preventing rebound pain following peripheral nerve blocks in adult surgical patients: a systematic review and network meta-analysis. Anaesthesia. 2025 Jun;80(6):704-712. doi: 10.1111/anae.16566. Epub 2025 Feb 10.

  PMID: 39929722 BACKGROUND

• Hamilton DL. Rebound pain: distinct pain phenomenon or nonentity? Br J Anaesth. 2021 Apr;126(4):761-763. doi: 10.1016/j.bja.2020.12.034. Epub 2021 Feb 5. No abstract available.

  PMID: 33551124 BACKGROUND

• Lavand'homme P. Rebound pain after regional anesthesia in the ambulatory patient. Curr Opin Anaesthesiol. 2018 Dec;31(6):679-684. doi: 10.1097/ACO.0000000000000651.

  PMID: 30124544 BACKGROUND

• Schubert AK, Wiesmann T, Volberg C, Riecke J, Schneider A, Wulf H, Dinges HC. Rebound pain and postoperative pain profile following brachial plexus block compared to general anaesthesia-An observational study. Acta Anaesthesiol Scand. 2023 Nov;67(10):1414-1422. doi: 10.1111/aas.14318. Epub 2023 Aug 29.

  PMID: 37642227 BACKGROUND

• Henningsen MJ, Sort R, Moller AM, Herling SF. Peripheral nerve block in ankle fracture surgery: a qualitative study of patients' experiences. Anaesthesia. 2018 Jan;73(1):49-58. doi: 10.1111/anae.14088. Epub 2017 Oct 19.

  PMID: 29052225 BACKGROUND

• Singla P, Ye Y, Elkassabany NM, Mariano ER. 'Pain as regional anaesthesia wears off' or 'rebound pain': what's in a name? Anaesthesia. 2025 Jun;80(6):607-611. doi: 10.1111/anae.16583. Epub 2025 Mar 3. No abstract available.

  PMID: 40032279 BACKGROUND

• Barry GS, Bailey JG, Sardinha J, Brousseau P, Uppal V. Factors associated with rebound pain after peripheral nerve block for ambulatory surgery. Br J Anaesth. 2021 Apr;126(4):862-871. doi: 10.1016/j.bja.2020.10.035. Epub 2020 Dec 31.

  PMID: 33390261 BACKGROUND

• Touil N, Pavlopoulou A, Barbier O, Libouton X, Gruson D, Gala JL, Lavand'homme P. Factors associated with a reduction in the preventive effect of intravenous dexamethasone on rebound pain after axillary brachial plexus block. Br J Anaesth. 2025 Oct;135(4):1059-1066. doi: 10.1016/j.bja.2025.05.055. Epub 2025 Jul 22.

  PMID: 40701886 BACKGROUND

• Munoz-Leyva F, Cubillos J, Chin KJ. Managing rebound pain after regional anesthesia. Korean J Anesthesiol. 2020 Oct;73(5):372-383. doi: 10.4097/kja.20436. Epub 2020 Aug 10.

  PMID: 32773724 BACKGROUND

• Chung AR, Mather RV, Gutierrez R, Liu R, Leung CFA, Zhang M, Santa Cruz Mercado LA, Houle TT, Bittner EA, Purdon PL. Association of peripheral nerve blocks with increased postoperative pain and opioid use in orthopaedic surgery: a single-centre retrospective cohort study. Br J Anaesth. 2025 Nov;135(5):1286-1296. doi: 10.1016/j.bja.2025.05.030. Epub 2025 Jul 3.

  PMID: 40610285 BACKGROUND

• Holmberg A, Hassellund SS, Draegni T, Nordby A, Ottesen FS, Gulestol A, Raeder J. Analgesic effect of intravenous dexamethasone after volar plate surgery for distal radius fracture with brachial plexus block anaesthesia: a prospective, double-blind randomised clinical trial. Anaesthesia. 2020 Nov;75(11):1448-1460. doi: 10.1111/anae.15111. Epub 2020 May 30.

  PMID: 32472958 BACKGROUND

• Yang ZS, Lai HC, Jhou HJ, Chan WH, Chen PH. Rebound pain prevention after peripheral nerve block: A network meta-analysis comparing intravenous, perineural dexamethasone, and control. J Clin Anesth. 2024 Dec;99:111657. doi: 10.1016/j.jclinane.2024.111657. Epub 2024 Oct 24.

  PMID: 39454286 BACKGROUND

• Sunderland S, Yarnold CH, Head SJ, Osborn JA, Purssell A, Peel JK, Schwarz SK. Regional Versus General Anesthesia and the Incidence of Unplanned Health Care Resource Utilization for Postoperative Pain After Wrist Fracture Surgery: Results From a Retrospective Quality Improvement Project. Reg Anesth Pain Med. 2016 Jan-Feb;41(1):22-7. doi: 10.1097/AAP.0000000000000325.

  PMID: 26650425 BACKGROUND

MeSH Terms

Conditions

Pain, Postoperative; Agnosia

Condition Hierarchy (Ancestors)

Postoperative Complications; Pathologic Processes; Pathological Conditions, Signs and Symptoms; Pain; Neurologic Manifestations; Signs and Symptoms; Perceptual Disorders; Neurobehavioral Manifestations; Nervous System Diseases

Central Study Contacts

Eric Albrecht, Prof.

CONTACT

+41 79 556 63 41; eric.albrecht@chuv.ch

Iliana Mrazek

CONTACT

+41 79 556 85 06; iliana.mrazek@chuv.ch

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: DOUBLE
• Who Masked: INVESTIGATOR, OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Prof. Dr. Med. Eric Albrecht, Associate Professor, University of Lausanne

Model Details: This is a single-center, prospective, superiority, randomized, double-blind, parallel-group study

Study Record Dates

• First Submitted: June 15, 2026
• First Posted: June 24, 2026
• Study Start: June 1, 2026
• Primary Completion (Estimated): September 1, 2027
• Study Completion (Estimated): September 1, 2027
• Last Updated: June 24, 2026

Record last verified: 2026-06

Data Sharing

• IPD Sharing: Will not share

Locations

CH (1)