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.

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.

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).

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.