Peripheral Nerve Blocks (PNBs) and Post-Op Pain: Help or Harm?

by Vince Vacketta, DPM

PNBs have become a popular tool for managing pain after orthopedic surgery, but a new look at nearly 23,000 patients at Massachusetts General Hospital suggests the story is more nuanced.

This single-center retrospective study compared patients who received single-injection PNBs with those who did not. In the recovery room, the benefits were clear: patients with PNBs reported lower peak pain scores and required fewer opioids. But once the block wore off, a different picture emerged: many experienced “rebound pain,” with higher maximum pain scores and about 23% greater total opioid use during the hospital stay than those without a block.

Key findings:

• Immediate recovery (PACU): Lower maximum pain scores and reduced opioid use with PNBs

• Later in the hospital stay: Rebound pain with higher maximum pain scores and 22.7% higher total opioid consumption

• After discharge: More opioid prescriptions at 30 days; no differences at 90 or 180 days

• At one year: Slightly lower rates of new chronic pain diagnoses

Overall, the study suggests that while PNBs offer excellent early relief, they may set patients up for a challenging rebound phase if not supported by a broader pain-management plan, 

The takeaway: PNBs ease immediate pain but can paradoxically heighten later pain and opioid use if not paired with a comprehensive pain-management plan.