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For perioperative pain management, esmolol can effectively provide pain relief, lessen the need for opioids and rescue analgesics.
Esmolol, an ultra-short acting β-blocker, given
intravenously, provides a rapid onset effect, but of short duration action. It
gives an unexampled level of tolerability and safety in the perioperative
setting.
Esmolol has been found to improve
postoperative pain and reduce opioid requirements. This systematic review and meta-analysis were performed
to evaluate the effect of perioperative esmolol as an adjunct on early
postoperative pain intensity, recovery profile, and anaesthetic requirement.
For this database of randomized placebo-controlled comparative trials
evaluating the effects of esmolol during general anaesthesia in all types of
surgery were reviewed.
It was searched in OVID MEDLINE
(1980–February 2014), OVID EMBASE, EBSCO, CINAHL, and the Cochrane Register.
This review studied 19 trials that involved 936 patients, divided into two
groups (esmolol = 470, placebo = 466). Inclusion criteria were based on that
the fact that at least one patient outcome or anaesthetic variables such as
pain scores, intraoperative and postoperative opioid consumption, emergence
time, PONV, and an anaesthetic requirement was reported, were included in the
meta-analysis.
The primary outcomes were like acute
postoperative pain scores at rest, cumulative opioid consumption, and rescue
analgesic administration. The secondary outcomes were associated with emergence
time, postoperative nausea and vomiting, and intraoperative anaesthetic
requirement.
In results, Esmolol group showed
reduction by 1.16 in the numeric pain scores at rest in the immediate
postoperative period (95% confidence interval [CI]: 1.97–0.35, I2 = 96.7%) out of 10. Also decrease in the opioid consumption in
the post anesthesia care unit compared with placebo, mean difference of 5.1 mg
(95% CI: 7.0–3.2, I2 = 96.9%)
morphine IV equivalents; Reduction in opioid rescue dosing by 69% was noted
(odds ratio [OR]: 0.31, 95% CI: 0.16–0.80,
I2 = 0.0%). Reduction by 61% was also observed in postoperative nausea and
vomiting (OR: 0.39, 95% CI: 0.20–0.75, I2
= 60.7%). In the esmolol group, reduction was noted in propofol induction dose
(mean difference: −0.53 mg/kg, 95% CI: −0.63–−0.44, I2 = 0.0%). A decrease in end-tidal desflurane equivalent (mean
difference: 1.70%, 95% CI: −2.39–−1.02, I2
= 92.0%) and intraoperative opioid usage (fentanyl equivalent, mean difference:
440 μg, 95% CI: −637–−244, 2 = 99.6%) was observed in esmolol group.
It was thus concluded that Esmolol
affects the emergence time. As an adjunct, perioperative Esmolol may reduce
postoperative pain intensity, opioid consumption, and postoperative nausea
vomiting. Given the heterogeneity, larger clinical trials are warranted to
confirm these findings.
Pain Physician
The effect of perioperative esmolol on early postoperative pain: A systematic review and meta-analysis
Nidal Elbaridi et al.
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