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Please confirm that an ethics committee approval has been applied for or granted: Yes: I’m uploading the Ethics Committee Approval as a PDF file with this abstract submissionApplication for ESRA Abstract PrizesBackground and Aims The combined use of brachial plexus block has been demonstrated to decrease the need for general anesthetics, reduce associated side effects, and enhance early postoperative analgesia. Nonetheless, once the nerve block effect subsides, patients occasionally report experiencing severe pain, a phenomenon identified as rebound pain. The factors contributing to rebound pain are not yet fully understood. This study investigates the incidence and factors associated with rebound pain in patients undergoing brachial plexus block for shoulder arthroscopic surgery.Methods This study included patients who underwent arthroscopic rotator cuff tear repair between January 2020 and March 2025. All patients received a combination of brachial plexus block and general anesthesia. Rebound pain was defined as an increase from a Numerical Rating Scale (NRS) score of ≤3, indicating an effective block, to an NRS score of >7 within 24 hours post-surgery when the block effect had dissipated. Patient characteristics, surgical factors, and anesthetic factors were analyzed for their association with the incidence of rebound pain. Statistically significant indicators were identified, and a multivariate logistic regression analysis was performed to determine the risk factors associated with rebound pain.Results Of 336 patients, 148 (44.1%) experienced rebound pain. Multivariate logistic regression identified dexamethasone use (OR 0.43, 95% CI 0.207–0.893, p=0.0237) and levobupivacaine choice (OR 0.260, 95% CI 0.107–0.633, p=0.0030) as independent factors associated with rebound pain.Conclusions Consistent with previous studies, rebound pain was observed in nearly half of the patients. Our study demonstrated that intravenous dexamethasone and levobupivacaine use effectively reduce the incidence of rebound pain.