Trial reportDrug design, development and therapy2025
Dexamethasone, but Not Esketamine, Reduces Rebound Pain After Interscalene Nerve Block: A Randomized Factorial Trial.
Trial report in Drug design, development and therapy, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
3 citing papers in PubMed.
- Comparison of the 4-in-1 block technique with femoral and adductor canal blocks in arthroscopic anterior cruciate ligament reconstruction: a randomized controlled trial.BMC anesthesiology · 2026Trial
- Personalized Multimodal and Opioid-Sparing Analgesia for Postoperative Pain Management: Enhancing Recovery and Addressing the Post-Discharge Gap.Journal of pain research · 2026Review
- Rebound pain following peripheral nerve block in extremity fracture surgery: pathophysiological mechanisms based on the "Triple-Hit" model and multimodal preventive strategies.Frontiers in medicine · 2026Review
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Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Background: Rebound pain following peripheral nerve block resolution is a distressing phenomenon that impairs recovery and commonly arises at night when treatment options are limited. Objective: To evaluate whether intravenous esketamine and/or dexamethasone, as adjuvants to interscalene ropivacaine block, reduce rebound pain after arthroscopic shoulder surgery. Design: A patient- and outcome assessor-blinded, randomized, controlled, 2×2 factorial clinical trial. Setting: A single tertiary-care academic hospital. Patients: A total of 160 adult patients undergoing arthroscopic shoulder surgery under general anaesthesia with single-shot interscalene brachial plexus block. Interventions: Patients were randomized to receive intravenous combinations of esketamine-placebo, placebo-dexamethasone, esketamine-dexamethasone, or placebo-placebo, in addition to ropivacaine block after induction of general anaesthesia and before surgical incision. Main Outcome Measures: Co-primary outcomes were: (1) the increase in pain score from before to after the ISB resolved; and (2) the incidence of severe rebound pain, defined as numerical rating scale (NRS) pain score ≥7. Results: All 160 patients completed the trial. Rebound pain occurred in 32% of patients, with no interaction between esketamine and dexamethasone. The pain score increased by 6.2 ± 2.5 in the placebo-placebo group versus 4.4 ± 2.5 in the esketamine-dexamethasone group (difference -1.8; 95% CI -2.9 to -0.7; P = 0.002). Dexamethasone significantly reduced the pain score increase compared to placebo (-1.7; 95% CI -2.8 to -0.6; P = 0.003), while esketamine alone did not. Severe rebound pain occurred in 22/80 (27%) of patients receiving esketamine versus 26/80 (32%) without (RR 0.84; 95% CI 0.50 to 1.41; P = 0.459), and in 18/80 (22%) of patients receiving dexamethasone versus 29/80 (36%) without (RR 0.62; 95% CI 0.38 to 0.89; P = 0.016). Conclusion: Intravenous dexamethasone, but not esketamine (low dose), significantly reduced the incidence and severity of rebound pain following interscalene nerve block. Trial Registration: Chinese Clinical Trial Registry (ChiCTR2300072416).
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