{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T04:47:24Z","timestamp":1765601244842,"version":"3.48.0"},"reference-count":29,"publisher":"BMJ","issue":"12","license":[{"start":{"date-parts":[[2024,12,12]],"date-time":"2024-12-12T00:00:00Z","timestamp":1733961600000},"content-version":"unspecified","delay-in-days":11,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2024,11,16]]},"published-print":{"date-parts":[[2024,12]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Supraclavicular brachial plexus block (SCB) is a common regional analgesic technique for upper limb fracture surgery, but it often leads to rebound pain. Our primary aim is to determine whether different administration methods of esketamine can reduce rebound pain in patients undergoing SCB for upper limb fracture surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods\/design<\/jats:title>\n                    <jats:p>\n                      This study is designed as a single-centre, double-blinded, prospective, randomised controlled trial. Patients undergoing upper limb fracture surgery, who plan to use a tourniquet, aged 18\u201360 years, with a body mass index of 18\u201330\u2009kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      and an American Society of Anaesthesiologists classification of I\u2013III will be randomised into three groups after providing written informed consent: group N (perineural esketamine\/ropivacaine); group V (intravenous esketamine\/perineural ropivacaine); and group C (perineural ropivacaine). The primary outcome will be the percentage of patients experiencing rebound pain within 24 hours postoperatively. Secondary outcomes include the Numeric Rating Scale (NRS) score of rebound pain, the onset of rebound pain, (since performing SCB), the cumulative area under the curve of NRS pain severity scores through 48 hours postsurgery, postoperative opioid consumption at 48 hours postoperatively, onset and duration of the sensory blockade, onset and duration of the motor blockade and adverse reactions and adverse events. Patients will be followed-up to 48 hours postoperatively.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussions<\/jats:title>\n                    <jats:p>This protocol describes the design of a randomised controlled trial to evaluate the effect of different modes of administration of esketamine combined with SCB on the incidence of rebound pain after upper limb fracture surgery. The results may help to identify the most effective methods for managing pain in patients undergoing upper limb fracture surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>This study has been approved by the Ethics Committee of the Deyang People\u2019s Hospital (2023-03-010-K01). It was registered on the Chinese Clinical Trials Registry on 24 August 2023. We intend to publish the results in a peer-reviewed journal.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>ChiCTR2300075083.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2024-088177","type":"journal-article","created":{"date-parts":[[2024,12,12]],"date-time":"2024-12-12T23:17:27Z","timestamp":1734045447000},"page":"e088177","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Effect of different modes of administration of esketamine combined with supraclavicular brachial plexus block on the incidence of rebound pain after upper limb fracture surgery: study protocol for a single-centre, double-blinded, randomised controlled trial"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-5406-233X","authenticated-orcid":false,"given":"Wencai","family":"Jiang","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, Deyang People's Hospital, Deyang, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-6129-4850","authenticated-orcid":false,"given":"Yanhua","family":"Peng","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Deyang People's Hospital, Deyang, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xuemeng","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Deyang People's Hospital, Deyang, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lijuan","family":"Fu","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Deyang People's Hospital, Deyang, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wenhu","family":"Zhai","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Deyang People's Hospital, Deyang, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xianjie","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Deyang People's Hospital, Deyang, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yukai","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Deyang People's Hospital, Deyang, China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2024,12,12]]},"reference":[{"key":"2025121220421451000_14.12.e088177.1","doi-asserted-by":"crossref","first-page":"e807","DOI":"10.1016\/S2214-109X(17)30222-X","article-title":"National incidence of traumatic fractures in China: a retrospective survey of 512\u2008187 individuals","volume":"5","author":"Chen","year":"2017","journal-title":"Lancet Glob Health"},{"key":"2025121220421451000_14.12.e088177.2","doi-asserted-by":"crossref","first-page":"1818","DOI":"10.12669\/pjms.39.6.7097","article-title":"Clinical application of upper limb fracture fixator in emergency treatment of upper limb fracture","volume":"39","author":"Xiong","year":"2023","journal-title":"Pak J Med Sci"},{"key":"2025121220421451000_14.12.e088177.3","first-page":"285","article-title":"Do All Fractures Need Surgery?","volume":"71","author":"Tejwani","year":"2022","journal-title":"Instr Course Lect"},{"key":"2025121220421451000_14.12.e088177.4","doi-asserted-by":"crossref","first-page":"547","DOI":"10.52628\/89.3.11357","article-title":"Wide-awake local anesthesia and no tourniquet (WALANT) in upper limb fractures","volume":"89","author":"Bansal","year":"2023","journal-title":"Acta Orthop Belg"},{"key":"2025121220421451000_14.12.e088177.5","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1016\/j.cjtee.2021.05.002","article-title":"Incidence and factors influencing tourniquet pain","volume":"24","author":"Kamath","year":"2021","journal-title":"Chin J Traumatol"},{"key":"2025121220421451000_14.12.e088177.6","doi-asserted-by":"crossref","first-page":"1751","DOI":"10.1016\/j.jse.2020.04.019","article-title":"Dexamethasone added to levobupivacaine prolongs the duration of interscalene brachial plexus block and decreases rebound pain after arthroscopic rotator cuff repair","volume":"29","author":"Morita","year":"2020","journal-title":"J Shoulder Elbow Surg"},{"key":"2025121220421451000_14.12.e088177.7","first-page":"57","article-title":"Regional and Multimodal Analgesia to Reduce Opioid Use after Total Joint Arthroplasty: A Narrative Review","volume":"15","author":"Soffin","year":"2019","journal-title":"HSS J Musculoskelet J Hosp Spec Surg"},{"key":"2025121220421451000_14.12.e088177.8","doi-asserted-by":"crossref","first-page":"949","DOI":"10.1080\/14656566.2019.1583743","article-title":"State of the art opioid-sparing strategies for post-operative pain in adult surgical patients","volume":"20","author":"Gabriel","year":"2019","journal-title":"Expert Opin Pharmacother"},{"key":"2025121220421451000_14.12.e088177.9","doi-asserted-by":"crossref","first-page":"734","DOI":"10.1016\/j.bja.2021.11.043","article-title":"Evaluation of intraoperative ketamine on the prevention of severe rebound pain upon cessation of peripheral nerve block: a prospective randomised, double-blind, placebo-controlled study","volume":"128","author":"Touil","year":"2022","journal-title":"Br J Anaesth"},{"key":"2025121220421451000_14.12.e088177.10","doi-asserted-by":"publisher","DOI":"10.1097\/AAP.0000000000000325"},{"key":"2025121220421451000_14.12.e088177.11","doi-asserted-by":"crossref","first-page":"862","DOI":"10.1016\/j.bja.2020.10.035","article-title":"Factors associated with rebound pain after peripheral nerve block for ambulatory surgery","volume":"126","author":"Barry","year":"2021","journal-title":"Br J Anaesth"},{"key":"2025121220421451000_14.12.e088177.12","doi-asserted-by":"crossref","DOI":"10.1186\/s12871-021-01267-z","article-title":"The effect of perineural dexamethasone on rebound pain after ropivacaine single-injection nerve block: a randomized controlled trial","volume":"21","author":"Fang","year":"2021","journal-title":"BMC Anesthesiol"},{"key":"2025121220421451000_14.12.e088177.13","doi-asserted-by":"crossref","first-page":"339","DOI":"10.5144\/0256-4947.2023.339","article-title":"Rebound pain after interscalene brachial plexus block for shoulder surgery: a randomized clinical trial of the effect of different multimodal analgesia regimens","volume":"43","author":"Et","year":"2023","journal-title":"Ann Saudi Med"},{"key":"2025121220421451000_14.12.e088177.14","doi-asserted-by":"crossref","first-page":"372","DOI":"10.4097\/kja.20436","article-title":"Managing rebound pain after regional anesthesia","volume":"73","author":"Mu\u00f1oz-Leyva","year":"2020","journal-title":"Korean J Anesthesiol"},{"key":"2025121220421451000_14.12.e088177.15","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1007\/s11916-023-01136-z","article-title":"Postoperative Rebound Pain: Our Current Understanding About the Role of Regional Anesthesia and Multimodal Approaches in Prevention and Treatment","volume":"27","author":"Luebbert","year":"2023","journal-title":"Curr Pain Headache Rep"},{"key":"2025121220421451000_14.12.e088177.16","doi-asserted-by":"publisher","DOI":"10.1136\/rapm-2021-102795"},{"key":"2025121220421451000_14.12.e088177.17","doi-asserted-by":"crossref","DOI":"10.3346\/jkms.2023.38.e183","article-title":"Intravenous Versus Perineural Dexamethasone for Reducing Rebound Pain After Interscalene Brachial Plexus Block: A Randomized Controlled Trial","volume":"38","author":"Lee","year":"2023","journal-title":"J Korean Med Sci"},{"key":"2025121220421451000_14.12.e088177.18","doi-asserted-by":"crossref","first-page":"1179673","DOI":"10.3389\/fneur.2023.1179673","article-title":"Effects of esketamine on postoperative rebound pain in patients undergoing unilateral total knee arthroplasty: a single-center, randomized, double-blind, placebo-controlled trial protocol","volume":"14","author":"Zhu","year":"2023","journal-title":"Front Neurol"},{"key":"2025121220421451000_14.12.e088177.19","doi-asserted-by":"crossref","first-page":"327","DOI":"10.36076\/ppj.2023.26.327","article-title":"Effect of S-ketamine on Postoperative Pain in Adults Post-Abdominal Surgery: A Systematic Review and Meta-analysis","volume":"26","author":"Xie","year":"2023","journal-title":"Pain Physician"},{"key":"2025121220421451000_14.12.e088177.20","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1016\/j.psc.2023.02.003","article-title":"Pharmacotherapy: Ketamine and Esketamine","volume":"46","author":"Feeney","year":"2023","journal-title":"Psychiatr Clin North Am"},{"key":"2025121220421451000_14.12.e088177.21","doi-asserted-by":"crossref","DOI":"10.1186\/s13063-023-07556-x","article-title":"The effects of esketamine and treatment expectation in acute major depressive disorder (Expect): study protocol for a pharmacological fMRI study using a balanced placebo design","volume":"24","author":"Falkenberg","year":"2023","journal-title":"Trials"},{"key":"2025121220421451000_14.12.e088177.22","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinane.2020.110071"},{"key":"2025121220421451000_14.12.e088177.23","doi-asserted-by":"crossref","DOI":"10.4088\/JCP.19m12891","article-title":"Esketamine Nasal Spray Plus Oral Antidepressant in Patients With Treatment-Resistant Depression: Assessment of Long-Term Safety in a Phase 3, Open-Label Study (SUSTAIN-2)","volume":"81","author":"Wajs","year":"2020","journal-title":"J Clin Psychiatry"},{"key":"2025121220421451000_14.12.e088177.24","doi-asserted-by":"crossref","DOI":"10.1186\/s12888-019-2359-1","article-title":"Oral esketamine for treatment-resistant depression: rationale and design of a randomized controlled trial","volume":"19","author":"Smith-Apeldoorn","year":"2019","journal-title":"BMC Psychiatry"},{"key":"2025121220421451000_14.12.e088177.25","doi-asserted-by":"crossref","DOI":"10.3389\/fpsyt.2024.1325399","article-title":"Efficacy and safety of ketamine and esketamine for unipolar and bipolar depression: an overview of systematic reviews with meta-analysis","volume":"15","author":"Rodolico","year":"2024","journal-title":"Front Psychiatry"},{"key":"2025121220421451000_14.12.e088177.26","doi-asserted-by":"crossref","first-page":"463","DOI":"10.2147\/DDDT.S448336","article-title":"Efficacy of Intravenous Administration of Esketamine in Preventing and Treating Rebound Pain After Thoracic Paravertebral Nerve Block: A Prospective Randomized, Double-Blind, Placebo-Controlled Trial","volume":"18","author":"Zeng","year":"2024","journal-title":"Drug Des Devel Ther"},{"key":"2025121220421451000_14.12.e088177.27","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1213\/ANE.0000000000006547","article-title":"Opioid-Free Versus Opioid-Based Anesthesia on Postoperative Pain After Thoracoscopic Surgery: The Use of Intravenous and Epidural Esketamine","volume":"137","author":"Yan","year":"2023","journal-title":"Anesth Analg"},{"key":"2025121220421451000_14.12.e088177.28","doi-asserted-by":"crossref","first-page":"548","DOI":"10.52312\/jdrs.2023.997","article-title":"A subanesthetic dose of esketamine combined with hip peripheral nerve block has good sedative and analgesic effects in elderly patients undergoing total hip arthroplasty: A randomized-controlled trial","volume":"34","author":"Dai","year":"2023","journal-title":"Jt Dis Relat Surg"},{"key":"2025121220421451000_14.12.e088177.29","doi-asserted-by":"crossref","first-page":"4022","DOI":"10.1007\/s00167-020-06288-8","article-title":"Dexmedetomidine combined with suprascapular nerve block and axillary nerve block has a synergistic effect on relieving postoperative pain after arthroscopic rotator cuff repair","volume":"29","author":"Lee","year":"2021","journal-title":"Knee Surg Sports Traumatol Arthrosc"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2024-088177","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T04:42:24Z","timestamp":1765600944000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2024-088177"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12]]},"references-count":29,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2024,12,12]]},"published-print":{"date-parts":[[2024,12]]}},"alternative-id":["10.1136\/bmjopen-2024-088177"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2024-088177","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"type":"print","value":"2044-6055"},{"type":"electronic","value":"2044-6055"}],"subject":[],"published":{"date-parts":[[2024,12]]}}}