Effect of distal forearm peripheral nerve block with liposomal bupivacaine on rebound pain after peripheral nerve block and postoperative rehabilitation in patients with hand trauma

ZHANG Jing-hao; HE Rui-qi; XIAO Su-jun; ZHANG Xue-kang

doi:10.20251/j.cnki.1003-3734.2026.13.007

Abstract：Objective:To investigate the impact of distal forearm peripheral nerve block(DPNB)with liposomal bupivacaine on rebound pain(RP)after peripheral nerve block and postoperative rehabilitation in patients with hand trauma.Methods:Patients with hand trauma,aged 18～65 years,body mass index(BMI)18～30 kg·m-2,and American Society of Anesthesiologists(ASA)physical status Ⅰ or Ⅱ,whose surgical area involved the innervation of the radial nerve,median nerve,and/or ulnar nerve,were selected.They were randomly divided into a liposomal bupivacaine group(group L)and a control group(group C)using a random number table,with 40 patients in each group.Both groups initially received an interscalene brachial plexus block(ISBPB)with 20 mL of a mixture of 0.375%ropivacaine and 0.5%lidocaine.In group L,the ulnar nerve,radial nerve or median nerve in the forearm were selected under ultrasound guidance according to the innervation of the surgical area,and 3 mL of 0.665%liposomal bupivacaine was injected perineurally around each selected nerve.Group C received no intervention.After surgery,all patients in both groups were equipped with patient-controlled intravenous analgesia(PCIA)pumps.The incidence of RP within 24 h postoperatively was recorded.Numerical rating scale(NRS)scores at rest and during movement were recorded before surgery,immediately upon leaving the operating room,and at 6,12,24,48 and 72 h postoperatively.The resting NRS score upon leaving the operating room,the modified rebound pain score(MRPS),and the cumulative opioid consumption within 72 h postoperatively were recorded.The durations of sensory and motor blockade were recorded.Muscle strength grades and modified Bromage scores were recorded before surgery and at 6,12,24,48 and 72 h postoperatively.The 15-item Quality of Recovery(QoR-15)scores were recorded before surgery and at 24,48 and 72 h postoperatively.Adverse reactions such as chest tightness,dizziness,nausea and vomiting were recorded after surgery.Results:Compared with group C,the incidence of RP within 24 h postoperatively was lower in group L(P<0.05).Compared with group C,the resting NRS scores at 6 and 12 h postoperatively were also lower(P<0.05),and the NRS scores during movement at 6 and 12 h postoperatively were also lower(P<0.05).Compared with group C,the MRPS and the cumulative opioid consumption within 72 h postoperatively were lower in group L(P<0.05).Compared with group C,the duration of sensory block was significantly prolonged in group L(P<0.05),while the duration of motor block,and the modified Bromage scores and muscle strength grades at 6,12,24,48 and 72 h postoperatively were not significantly different(all P>0.05).Compared with group C,the QoR-15 scores at 24,48 and 72 h postoperatively were higher in group L(P<0.05).There were no statistically significant differences in the incidence of postoperative adverse reactions between the two groups(P>0.05).Conclusion:Distal forearm peripheral nerve block with liposomal bupivacaine effectively reduces the incidence of RP in hand trauma patients,provides analgesia for up to 12 h postoperatively,and promotes postoperative rehabilitation.