Does esmolol infusion have an adjuvant effect on transversus abdominis plane block for pain control in laparoscopic cholecystectomy? A randomized controlled double-blind trial

Abstract

Background: Both intraoperative esmolol and transversus abdominis plane (TAP) block facilitate postoperative analgesia after laparoscopic cholecystectomy as part of multimodal analgesia. Both strategies can minimize the use of postoperative opioids. In current study, our goal was to assess if intra-operative esmolol infusion in association with TAP block can overcome the deficits of TAP block alone after laparoscopic cholecystectomy. Methods: This prospective, randomized and double-blinded clinical trial included 60 patients of either sex who scheduled for elective laparoscopic cholecystectomy; received either ultrasound-guided TAP block alone or in association with intravenous esmolol bolus (0.5 mg/kg) before induction followed by a maintenance infusion (0.05 mg/kg/min) till the end of operation. Intra-operative hemodynamic parameters were followed up. Postoperatively, in order to maintain visual analogue scale (VAS) scores ≤3, patients received IV morphine. The primary outcome was amount of opioid consumption during the first 24 hours postoperative. Pain scores, mean arterial pressure (MAP), heart rate (HR) and occurrence of nausea/vomiting were secondary outcomes. Results: The mean morphine consumption after surgery in patients receiving esmolol was (5.83) mg compared to (7.5) mg in TAP only group (p = 0.204). The mean pain scores at early postoperative hours were significantly lower in esmolol group (p < 0.05). MAP and HR were significantly lower in esmolol group intraoperative; however, no variance was detected later. Conclusion:In the first 24 hours following surgery, esmolol infusion increased the analgesic impact of TAP block in terms of opioid demand and pain severity.

Transversus Abdominis Plane Block as a Strategy for Effective Pain Management in Patients with Pain during Laparoscopic Cholecystectomy: A Systematic Review

“…Again, the same concentration of 0.2% Ropivacaine with an additional 4 mg/kg Dexamethasone was used for different TAP block procedures, and the US-ESP group had less postoperative pain and required fewer opioids than the OSTAP block group [ 92 ]. The addition of 0.5 mg/kg Esmolol to the local anesthetic for TAP block infiltration is more effective for pain management than the addition of 0.9% normal saline [ 89 ]. Again, administration of a local anesthetic percutaneously or subcutaneously or between obliquus internus and transversus abdominis or in the sub-diaphragmatic and pericholecystic areas is more effective than normal saline.…”

“…A few studies have contributed to the understanding of the modulation of postoperative pain by Esmolol, although its role in modulating pain still remains unclear [ 89 ]. Analgesic effects of beta-adrenergic antagonists are mediated by G proteins that are activated in isolated cell membranes [ 108 ].…”

“…In contrast, it has been found that Levobupivacaine 0.375% and 0.9% saline groups consumed similar amounts of opioids 24 h after surgery: 21.2 mg versus 25.2 oral Morphine equivalent; p = 0.48 [ 79 ]. Mean Morphine consumption after surgery in patients receiving US-TAP block (Esmolol) was 5.83 mg ( p = 0.204) compared with US-TAP block (saline) (7.5 mg, p = 0.204) [ 89 ]. The US-TAP block (Esmolol) group had significantly lower early postoperative pain scores ( p = 0.05) [ 89 ].…”

“…Mean Morphine consumption after surgery in patients receiving US-TAP block (Esmolol) was 5.83 mg ( p = 0.204) compared with US-TAP block (saline) (7.5 mg, p = 0.204) [ 89 ]. The US-TAP block (Esmolol) group had significantly lower early postoperative pain scores ( p = 0.05) [ 89 ]. From arrival at PACU to 12 h postoperative, the mean analgesic requirement appears to be higher for the US-TAP block (saline) (2.5 to 0.1) than for the US-TAP block (Esmolol) (2.16 to −0.04) (Abdelfatah& Amin, 2021).…”