Rebound Pain After Peripheral Nerve Block
Conditions
Interventions
Experimental group:Intravenous infusion of esmolol will be initiated 5 minutes before skin incision and maintained at 10 µg/kg/min until the completion of surgical skin closure.
Control group:Intraoperative intravenous infusion of an equal volume of 0.9% normal saline (placebo control)
Sponsors
Fujian Medical University Union Hospital
Eligibility
Sex/Gender
All
Age
18 Years to 80 Years
Inclusion criteria
Inclusion criteria: 1. Patients aged 18–85 years, with no gender restriction; 2. Body mass index (BMI) between 18.5 and 31.9; 3. Patients with American Society of Anesthesiologists (ASA) physical status classification I–III; 4. Patients scheduled for elective unilateral total knee arthroplasty (TKA) or unicompartmental knee arthroplasty (UKA): (1) Significant knee pain affecting daily activities with limited painless walking distance (<500 meters); (2) Poor response to conservative treatment; (3) Imaging findings showing significant knee joint degeneration or structural damage; 5. Patients diagnosed with at least one of the following conditions: Knee osteoarthritis; Rheumatoid arthritis; Traumatic arthritis; Primary or secondary osteonecrosis of the knee; 6. Patients who voluntarily participate in the study and provide written informed consent.
Exclusion criteria
Exclusion criteria: 1.General conditions and contraindications to esmolol: (1) Patients with known hypersensitivity to esmolol or other ß-adrenergic blockers; (2) Severe bronchial asthma, acute exacerbation of chronic obstructive pulmonary disease; (3) Sinus bradycardia (heart rate 100 beats/min); (7) Severe hepatic or renal dysfunction (e.g., Child–Pugh class C liver disease or creatinine clearance < 35 mL/min); (8) Patients receiving long-term treatment with ß-blockers, a2-adrenergic agonists, or other potent heart rate-controlling medications that may interfere with intraoperative hemodynamic management or evaluation of rebound pain. 2.Contraindications to peripheral nerve block: (1) Patients with local infection at the puncture site, sepsis, severe coagulation disorders, or those receiving anticoagulant/antiplatelet therapy that has not been discontinued for an appropriate safety interval; (2) Patients with anatomical abnormalities, previous surgery, or trauma resulting in altered fascia iliaca compartment anatomy, making standardized fascia iliaca compartment block technically infeasible. 3.Surgery- and analgesia-related exclusions: Patients with a history of previous surgery on the ipsilateral knee; intraoperative conversion of the planned surgical procedure; refusal to use patient-controlled analgesia (PCA); inability to cooperate with postoperative pain assessment; or inability to undergo bispectral index (BIS) monitoring. 4.Follow-up-related exclusions: Patients with severe psychiatric disorders, cognitive impairment, or communication difficulties that may affect pain assessment or follow-up, including uncontrolled schizophrenia, severe depression, or other conditions considered by investigators to impair study participation. 5.Other exclusions: Patients with a history of chronic pain or long-term opioid use; pregnant or breastfeeding women; and patients who are concurrently participating in other clinical trials.
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| incidence of rebound pain after peripheral nerve block; | — |
Secondary
| Measure | Time frame |
|---|---|
| Time to first request for rescue analgesia;Area under the curve of numerical rating scale (NRS) pain scores over time;Total perioperative opioid consumption, expressed in morphine milligram equivalents (MME);Sensory/motor block duration;Adverse Events; | — |
Countries
China
Contacts
Public ContactLiangcheng Zhang
Fujian Medical University Union Hospital
Outcome results
None listed