Intraoperative Esmolol: Can It Reduce the Need of Postoperative Opioid in Laparoscopic Cholecystectomy Patients?
Journal of Cellular & Molecular Anesthesia,
Vol. 6 No. 1 (2021),
17 March 2021
,
Page 15-23
https://doi.org/10.22037/jcma.v6i1.32524
Abstract
Background: Laparoscopic cholecystectomy may be associated with postoperative pain mandating rescue analgesics; intraoperative β-blocker (Esmolol) might improve analgesia and spare opioids. This study was performed to test this potential beneficial effect of intraoperative Esmolol in patients undergoing general anesthesia for laparoscopic cholecystectomy. Materials and Methods: A total of 100 patients of the American sociological association (ASA) physical status-1 scheduled for laparoscopic cholecystectomy under general anesthesia were included. Patients receiving Esmolol were assessed for its effect on postoperative analgesia concerning those who did not receive Esmolol. Esmolol was administered as a bolus dose (0.5mg/kg) just before induction of anesthesia followed by an infusion rate of 0.05mg/kg/min until the completion of surgery. Results: Patients in the Esmolol group and the control group were compared. A significant difference in postoperative visual analog scale (p<0.001), need for opioid analgesics (p<0.001), and the time for rescue analgesia (p<0.001) was observed, with the Esmolol group performing better. We also observed a better hemodynamic profile in patients receiving Esmolol as compared to the control group in the postoperative period. The difference in postoperative complications was not statistically significant (p=0.374). Conclusion: intraoperative Esmolol significantly reduced the postoperative opioids (analgesia) consumption and improved analgesia. The hemodynamic profile of the patients who received intraoperative Esmolol was significantly better. There was no statistically significant difference between study groups regarding intra- and postoperative complications. No major adverse event is noted with the use of Esmolol.- HR Heart Rate, NIBP Noninvasive Blood Pressure, RR Respiratory Rate, ECG Electrocardiography, EtCO2 end tidal carbon dioxide, VAS Visual Analog Scale.
How to Cite
References
Chung F. Recovery pattern and home-readiness after ambulatory surgery. Anesth Analg. 1995;80(5):896-902.
Fortier J, Chung F, Su J. Unanticipated admission after ambulatory surgery--a prospective study. Can J Anaesth. 1998;45(7):612-9.
Gold BS, Kitz DS, Lecky JH, Neuhaus JM. Unanticipated admission to the hospital following ambulatory surgery. JAMA. 1989;262(21):3008-10.
Bonnet F, Marret E. Influence of anaesthetic and analgesic techniques on outcome after surgery. Br J Anaesth. 2005;95(1):52-8.
Zhao SZ, Chung F, Hanna DB, Raymundo AL, Cheung RY, Chen C. Dose-response relationship between opioid use and adverse effects after ambulatory surgery. J Pain Symptom Manage. 2004;28(1):35-46.
Garnock-Jones KP. Esmolol: a review of its use in the short-term treatment of tachyarrhythmias and the short-term control of tachycardia and hypertension. Drugs. 2012;72(1):109-32.
Chia YY, Chan MH, Ko NH, Liu K. Role of beta-blockade in anaesthesia and postoperative pain management after hysterectomy. Br J Anaesth. 2004;93(6):799-805.
Lee SJ, Lee JN. The effect of perioperative esmolol infusion on the postoperative nausea, vomiting and pain after laparoscopic appendectomy. Korean J Anesthesiol. 2010;59(3):179-84.
Coloma M, Chiu JW, White PF, Armbruster SC. The use of esmolol as an alternative to remifentanil during desflurane anesthesia for fast-track outpatient gynecologic laparoscopic surgery. Anesth Analg. 2001;92(2):352-7.
Bhawna, Bajwa SJ, Lalitha K, Dhar P, Kumar V. Influence of esmolol on requirement of inhalational agent using entropy and assessment of its effect on immediate postoperative pain score. Indian J Anaesth. 2012;56(6):535-41.
Bajracharya JL, Subedi A, Pokharel K, Bhattarai B. The effect of intraoperative lidocaine versus esmolol infusion on postoperative analgesia in laparoscopic cholecystectomy: a randomized clinical trial. BMC Anesthesiol. 2019;19(1):198.
Dhir R, Singh MR, Kaul TK, Tewari A, Oberoi R. Effect of intravenous esmolol on analgesic requirements in laparoscopic cholecystectomy. J Anaesthesiol Clin Pharmacol. 2015;31(3):375-9.
Vahabi S, Rafieian Y, Abbas Zadeh A. The Effects of Intraoperative Esmolol Infusion on the Postoperative Pain and Hemodynamic Stability after Rhinoplasty. J Invest Surg. 2018;31(2):82-8.
Celebi N, Cizmeci EA, Canbay O. [Intraoperative esmolol infusion reduces postoperative analgesic consumption and anaesthetic use during septorhinoplasty: a randomized trial]. Rev Bras Anestesiol. 2014;64(5):343-9.
Watts R, Thiruvenkatarajan V, Calvert M, Newcombe G, van Wijk RM. The effect of perioperative esmolol on early postoperative pain: A systematic review and meta-analysis. J Anaesthesiol Clin Pharmacol. 2017;33(1):28-39.
White PF. The role of non-opioid analgesic techniques in the management of pain after ambulatory surgery. Anesth Analg. 2002;94(3):577-85.
Lee MH, Chung MH, Han CS, Lee JH, Choi YR, Choi EM, et al. Comparison of effects of intraoperative esmolol and ketamine infusion on acute postoperative pain after remifentanil-based anesthesia in patients undergoing laparoscopic cholecystectomy. Korean J Anesthesiol. 2014;66(3):222-9.
Hwang WJ, Moon YE, Cho SJ, Lee J. The effect of a continuous infusion of low-dose esmolol on the requirement for remifentanil during laparoscopic gynecologic surgery. Journal of clinical anesthesia. 2013;25(1):36-41.
- Abstract Viewed: 149 times
- PDF Downloaded: 199 times