Intraoperative Esmolol as an Adjunct for Perioperative Opioid and Postoperative Pain Reduction: A Systematic Review, Meta-analysis, and Meta-regression

Gelineau, Amanda; King, Michael R.; Ladha, Karim; Burns, Stacey; Houle, Timothy T.; Anderson, Thomas A.

doi:10.1213/ane.0000000000002469

Cited by 62 publications

(53 citation statements)

References 53 publications

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“…In recent developments, esmolol (at infusion doses of 5-50 mcg/kg/min) not only demonstrates an opioid-sparing effect (decrease opioid requirements intraoperatively and consumption postoperatively, although no apparent change in postoperative pain scores 24 ), but also is associated with a decreased time to discharge home (eg, after ambulatory surgery). The primary limitation regarding conclusions-todate addressing esmolol use intraoperatively is the relatively small sample sizes in the studies reviewed above.…”

Section: Discussionmentioning

confidence: 99%

“…In 11 of the trials (n = 688), there was insufficient evidence of change in postoperative 1-hour pain scores. 24 This seems to emphasize the notion that esmolol in isolation is unlikely to contribute to analgesia but is indeed associated with successful opioid sparing.…”

Section: Antinociceptive Properties Of Esmolol Based On Clinical Compmentioning

confidence: 94%

“…20 A recent meta-analysis demonstrated that intraoperative esmolol use reduces both intraoperative and postoperative opioid consumption, however, with no change in postoperative pain scores. 24 This meta-analysis included 23 studies. In 7 of the trials identified (n = 433), intraoperative use of esmolol reduced intraoperative opioid consumption.…”

Section: Antinociceptive Properties Of Esmolol Based On Clinical Compmentioning

confidence: 99%

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

Bahr

Williams

2018

Regional Anesthesia and Pain Medicine

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β-Adrenergic blockade is an important mechanism for reducing morbidity and mortality in patients with hypertension and heart failure. Esmolol has been used widely for its chronotropic and antihypertensive effects. However, there has been recent inquiry regarding perioperative esmolol use and nociceptive modulation. Conventional postoperative analgesic treatment has relied primarily on opioids, which present their own adverse effects and pharmacoepidemiologic repercussions. Esmolol, to date, has not shown any direct analgesic or anesthetic properties; however, recent studies suggest that esmolol may have antinociceptive and postoperative opioid-sparing effects. In this Daring Discourse narrative, we describe the role of esmolol in current perioperative β-blockade guidelines (related to noncardiac surgery), briefly describe studies supporting the antinociceptive effects of esmolol, propose mechanisms for esmolol antinociception, and forecast potential routine esmolol use intraoperatively (as part of a multimodal total intravenous anesthetic) and its effects on opioid sparing. The reading audience of regional anesthesiologists and acute pain medicine physicians is uniquely positioned to take a lead role in promulgating this care advance amid (i) the unwanted effects of the opioid epidemic and (ii) the uncertain notion of whether routine general anesthesia care (with fentanyl) may indirectly be contributing to the epidemic.

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Section: Discussionmentioning

confidence: 99%

Section: Antinociceptive Properties Of Esmolol Based On Clinical Compmentioning

confidence: 94%

Section: Antinociceptive Properties Of Esmolol Based On Clinical Compmentioning

confidence: 99%

See 1 more Smart Citation

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

Bahr

Williams

2018

Regional Anesthesia and Pain Medicine

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“…[12][13][14] A recent meta-analysis has revealed a significant reduction in perioperative opioid consumption with the use of intraoperative esmolol. 15 Although both lidocaine and esmolol are widely used for LC, studies comparing these agents are very few with conflicting results. 16 17 Therefore, the primary objective of our study was to compare the effects of intraoperative lidocaine and esmolol infusion on postoperative opioid consumption and pain scores following LC.…”

Section: Introductionmentioning

confidence: 99%

The effect of intraoperative lidocaine versus esmolol infusion on postoperative analgesia in laparoscopic cholecystectomy: A randomized clinical trial

Bajracharya

Subedi²,

Pokharel

et al. 2019

Preprint

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As a part of multimodal analgesia for laparoscopic cholecystectomy, both intraoperative lidocaine and esmolol facilitate postoperative analgesia. Our objective was to compare these two emerging strategies that challenge the use of intraoperative opioids. We aimed to assess if intraoperative esmolol infusion is not inferior to lidocaine infusion for opioid consumption after laparoscopic cholecystectomy. Methods: In this prospective, randomized, double-blind, non-inferiority clinical trial, 90 female patients scheduled for elective laparoscopic cholecystectomy received either intravenous (IV) lidocaine bolus 1.5 mg/kg at induction followed by an infusion (1.5 mg/ kg/hour) or IV bolus of esmolol 0.5 mg/kg at induction followed by an infusion (5-15 µg/kg/min) till the end of surgery. Remaining aspect of anesthesia followed a standard protocol apart from no intraoperative opioid supplementation. Postoperatively, patients received either morphine or tramadol IV to maintain visual analogue scale (VAS) scores ≤ 3. The primary outcome was opioid consumption (in morphine equivalents) during the first 24 postoperative hours. Pain and sedation scores, time to first perception of pain and void, and occurrence of nausea/vomiting were secondary outcomes measured up to 24 hours postoperatively. Results: Two patients in each group were excluded from the analysis. The postoperative median (IQR) morphine equivalent consumption in patients receiving esmolol was 1 (0-1.5) mg compared to 1.5 (1-2) mg in lidocaine group ( p =0.27). The median pain scores at various time points were similar between the two groups ( p >0.05). More patients receiving lidocaine were sedated in the post-anesthesia care unit (PACU) than those receiving esmolol (p<0.05); however, no difference was detected later. Conclusion: Infusion of esmolol is not inferior to lidocaine in terms of opioid requirement and pain severity in the first 24 hours after surgery. Patients receiving lidocaine were more sedated during their stay in PACU than those receiving esmolol.

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“…The meta-analysis by Gelineau et al 4 was available to us as an electronic publication ahead of print, and was included in our citations with the narrative phrases involving esmolol’s ‘decrease (in) opioid requirements intraoperatively and consumption postoperatively, although no apparent change in postoperative pain scores’ and ‘This seems to emphasize the notion that esmolol in isolation is unlikely to contribute to analgesia but is indeed associated with successful opioid sparing.’…”

mentioning

confidence: 99%

Esmolol: a viable option for current antinociceptive clinical research

Williams

2019

Reg Anesth Pain Med

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Intraoperative Esmolol as an Adjunct for Perioperative Opioid and Postoperative Pain Reduction: A Systematic Review, Meta-analysis, and Meta-regression

Abstract: This meta-analysis demonstrates that intraoperative esmolol use reduces both intraoperative and postoperative opioid consumption, with no change in postoperative pain scores.

Cited by 62 publications

References 53 publications

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

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

The effect of intraoperative lidocaine versus esmolol infusion on postoperative analgesia in laparoscopic cholecystectomy: A randomized clinical trial

Esmolol: a viable option for current antinociceptive clinical research

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