Esmolol, Antinociception, and Its Potential Opioid-Sparing Role in Routine Anesthesia Care

Bahr, Marshall; Williams, Brian A.

doi:10.1097/aap.0000000000000873

Cited by 13 publications

(17 citation statements)

References 36 publications

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“…Similarly, esmolol has been investigated as a synergistic analgesic intraoperatively. Esmolol may contribute to antinociception by blunting sympathetic arousal transmission through β-adrenergic receptor antagonism, but mechanisms and benefits are still being elucidated [324,325].…”

Section: Systemic Multimodal Adjunctsmentioning

confidence: 99%

Perioperative Pain Management and Opioid Stewardship: A Practical Guide

et al. 2021

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Surgical procedures are key drivers of pain development and opioid utilization globally. Various organizations have generated guidance on postoperative pain management, enhanced recovery strategies, multimodal analgesic and anesthetic techniques, and postoperative opioid prescribing. Still, comprehensive integration of these recommendations into standard practice at the institutional level remains elusive, and persistent postoperative pain and opioid use pose significant societal burdens. The multitude of guidance publications, many different healthcare providers involved in executing them, evolution of surgical technique, and complexities of perioperative care transitions all represent challenges to process improvement. This review seeks to summarize and integrate key recommendations into a “roadmap” for institutional adoption of perioperative analgesic and opioid optimization strategies. We present a brief review of applicable statistics and definitions as impetus for prioritizing both analgesia and opioid exposure in surgical quality improvement. We then review recommended modalities at each phase of perioperative care. We showcase the value of interprofessional collaboration in implementing and sustaining perioperative performance measures related to pain management and analgesic exposure, including those from the patient perspective. Surgery centers across the globe should adopt an integrated, collaborative approach to the twin goals of optimal pain management and opioid stewardship across the care continuum.

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Section: Systemic Multimodal Adjunctsmentioning

confidence: 99%

Perioperative Pain Management and Opioid Stewardship: A Practical Guide

et al. 2021

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“… 23 Esmolol itself has no analgesic effect, but some studies consider that its auxiliary analgesic effect is achieved through extending the effect of opioids. 24 In this study, different doses of esmolol do not affect the dosage of postoperative analgesic drugs. It may be that all patients in this trial took QLB before surgery, which is a new trunk block method based on the transverse abdominis plane block (TAPB).…”

Section: Discussionmentioning

confidence: 60%

Effect of Different Concentrations of Esmolol on Perioperative Hemodynamics and Analgesia in Patients Undergoing Colectomy: A Prospective, Randomized Controlled Study

Song¹,

Yan-wu²,

Peng³

et al. 2021

DDDT

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Purpose The aim of this study was to investigate the efficacy of esmolol on intraoperative hemodynamic and perioperative analgesic management. Methods Totally, 125 patients undergoing colectomy were randomly divided into three groups. Group S (saline group) was administered 0.75 mL/kg/h of normal saline for 5 min before anesthesia induction and maintenance of 0.25 mL/kg/h; Group E 1 and Group E 2 were administered 0.5 mg/kg and 1.0 mg/kg esmolol for 5 min before anesthesia induction, and maintained of 0.5 mg/kg/h and 2.0 mg/kg/h, respectively. Several parameters including indexes of hemodynamics variation (primary outcome), intra- and postoperative analgesic usage, and pain score were measured. Results Group E 1 and Group E 2 had significantly lower intubation response than Group S (P = 0.007, P = 0.001), and extubation response of Group E 2 was significantly lower than Group S (P = 0.007). The opioid consumption in Group E 1 and Group E 2 was significantly lower than in Group S intraoperatively (P = 0.020 and 0.007). The incidence of postoperative adverse reactions among the three groups was not statistically significant (P = 0.368 and 0.772). Conclusion Esmolol 0.5 mg/kg and 1.0 mg/kg infusion before intubation both can effectively inhibit the intubation response, while only maintenance with 2.0 mg/kg/h of esmolol can reduce the incidence of extubation response. At the same time, esmolol can decrease intraoperative opioid requirement without increasing the risk of adverse reactions. Trial Registration ChiCTR1900024538 and the date of registration was July 15, 2019 at http://www.chictr.org.cn .

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“…Окреме місце посідає есмолол в анестезіології. Метааналіз 73 досліджень вказує, що інтраопераційне введення есмололу дозволяє зменшити використання опіоїдів як під час, так і після хірургічних втручань [9,10,11,12]. Викликає зацікавленість медичної спільно ти використання есмололу для кардіопротекції під час хірургічних втручань, як у кардіохірургії, так і опера тивних втручань інших локалізацій.…”

Section: вступunclassified

Effect of short-acting b--blockers on heart rate and blood pressure in patients with acute coronary syndrome during percutaneous and coronary intervention

Распутіна¹,

Didenkо²,

Solomonchyk³

2021

prmd

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Background. The use of b- blockers in acute coronary syndrome (ACS) is recommended for all patients, who has not contraindications. The study of the effects of esmolol during percutaneous coronary intervention (PCI) remains relevant. Objective. To evaluate the features of the effect of esmolol (Biblock, “YURiA-PHARM”) on heart rate and blood pressure in patients with ACS during PCI.Materials and methods. The study included 30 patients, 15 men and 15 women, who were hospitalized in a specialized cardiology department with ACS with elevation of the ST segment. All patients underwent a general clinical examination, ECG recording in 12 leads, PCI according to the standard protocol with ECG and blood pressure monitoring. All patients were given infusion of esmolol before the standard therapy. The level of heart rate reduction, systolic blood pressure (SBP), diastolic blood pressure (DBP), the correlation of heart rate reduction during esmolol infusion with the clinical and functional parameters of patients and the degree of coronary artery (CA) damage were analyzed.Results. Decreased heart rate and blood pressure during infusion of esmolol in all patients. Before the infusion, the heart rate av-eraged (109.8 ± 4.0) beats per minute. After the infusion – (92.8 ± 3.2) beats per minute, (p < 0.001) with an average duration of infusion (18.2 ± 2.3) minutes. The decrease in SBP levels during infusion occurred on average by (22.8 ± 2.5) mm Hg, DBP – by (16.0 ± 2.1) mm Hg, no patient had hypotension. According to the results of correlation analysis, it was found that the decrease in heart rate with the use of esmolol has a correlation with the average age of patients (r = -0.47, p = 0.0012), with the presence of multivascular coronary artery disease (r = -0.38, p = 0.002). Weaker negative correlation was found with the initial level of SBP (r = -0.28, p = 0.015), the presence of a history of myocardial infarction (r = -0.27, p = 0.005), the presence of signs of left ventricular hypertrophy (LVH) on the ECG (r = -0.22, p = 0.008), and a history of arterial hypertension that was not treated according to current recommendations (r = -0.21, p = 0.032).Conclusions. The use of esmolol solution in patients with ACS who have supraventricular tachycardia and elevated blood pressure during PCI can improve control of heart rate, SBP and DBP, a significant decrease is observed after 10 minutes of dose titration. Careful titration of esmolol solution and monitoring of ECG and blood pressure revealed no side effects, including bradycardia and hypotension, which indicates a high safety profile of the drug.

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Esmolol, Antinociception, and Its Potential Opioid-Sparing Role in Routine Anesthesia Care

Cited by 13 publications

References 36 publications

Perioperative Pain Management and Opioid Stewardship: A Practical Guide

Perioperative Pain Management and Opioid Stewardship: A Practical Guide

Effect of Different Concentrations of Esmolol on Perioperative Hemodynamics and Analgesia in Patients Undergoing Colectomy: A Prospective, Randomized Controlled Study

Effect of short-acting b--blockers on heart rate and blood pressure in patients with acute coronary syndrome during percutaneous and coronary intervention

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