Peripheral nerve blocks for perioperative analgesia: das Kind mit dem Bade ausschütten...throwing the baby out with the bathwater?

There are many benefits of using peripheral nerve blocks (PNBs) for perioperative anaesthesia and analgesia; however, one of their major drawbacks is rebound pain upon resolution of the block. In examining a database of approximately 23 000 patients who received PNB along with general anaesthesia for orthopaedic surgery, Chung and colleagues found that PNB administration before incision was associated with lower maximum pain scores and lower opioid use in the postanaestheisa care unit, but was also associated with higher maximum pain scores, a 23% increase in opioid consumption during the hospital stay, and an increase in opioid prescriptions at 30 days after discharge. They also found that the use of single-shot PNBs was associated with decreased chronic pain diagnoses 1 year after surgery. Some of the discordant findings in this study might be attributed to its retrospective nature and the use of databases to examine this issue.