The effect of esmolol compared to opioids on postoperative nausea and vomiting, postanesthesia care unit discharge time, and analgesia in noncardiac surgery: A meta-analysis

Thiruvenkatarajan, Venkatesan; Watts, Richard W.; Calvert, Marni; Newcombe, G.; Wijk, Roelof Van

doi:10.4103/0970-9185.209747

Cited by 15 publications

(5 citation statements)

References 29 publications

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“…Thus, it is reasonable to assume that the lower incidence of PONV-related events in the intervention group resulted from the anaesthetic and opioid-sparing properties of esmolol. 11,27,28 But in addition, we cannot rule out the hypothesis that the more stable cardiovascular system seen in women of the esmolol group may also have…”

Section: Discussionmentioning

confidence: 92%

Intra-operative esmolol and pain following mastectomy

Mendonça

Tramontini

Miake

et al. 2021

European Journal of Anaesthesiology

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BACKGROUND Esmolol is a beta-1 selective blocker that has been shown to reduce postoperative pain. Its antinociceptive effects have not been tested following mastectomy. OBJECTIVE To evaluate the safety, efficacy and antinociception of intra-operative esmolol infusion after mastectomy. DESIGN Randomised, double-blinded, placebo-controlled trial. SETTING Tertiary referral centre, Brasília, Brazil. Recruitment: July 2015 to July 2017. PATIENTS Seventy women scheduled for mastectomy, ASA I to III, aged 18 to 75 years. Four were excluded. INTERVENTIONS All underwent general anaesthesia. The intervention group received a bolus of 0.5 mg kg−1 of esmolol over 10 min followed by a continuous infusion of 100 μg kg−1 min−1. The placebo group received saline. MAIN OUTCOME MEASURES The primary outcome was pain at rest 24 h after mastectomy as measured by a 0 to 10 numeric rating scale. RESULTS Pain scores at rest 24 h after mastectomy were lower in esmolol-treated patients compared with placebo (mean difference = −1.51, 95% confidence interval (CI), −2.36 to −0.65, P = 0.001). On arrival in the postanaesthesia care unit (PACU), the occurrence of pain was also lower in the esmolol group, at rest and on effort (P = 0.009 and P = 0.013, respectively), on discharge from PACU (P = 0.009 and P = 0.015), 12 h (P = 0.01 and P = 0.007) and on effort in the 24 postoperative hours (P = 0.003). Mean morphine consumption was reduced by 77% in the esmolol group compared with the placebo group (mean difference = −2.52 mg, 95% CI = −3.67 to −1.38, P < 0.001). The length of hospital stay was shorter for the esmolol group (mean difference = −6.9 h, 95% CI, −13.4 to −0.31, P = 0.040). CONCLUSION Esmolol was well tolerated, allowed a notable reduction in the dose of rescue analgesics and demonstrated superior efficacy compared to placebo for pain management after mastectomy. TRIAL REGISTRATION ClinicalTrials/NCT02466542

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Section: Discussionmentioning

confidence: 92%

Intra-operative esmolol and pain following mastectomy

Mendonça

Tramontini

Miake

et al. 2021

European Journal of Anaesthesiology

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“…In animal models, these receptors are co-expressed at the sarcolemma of cardiomyocytes [ 30 – 32 ]. This might explain that Esmolol was shown to diminish sympathetic excitation perioperatively caused by PONV in the literature [ 9 – 11 ]. However, it is unclear if these effects could also apply to a chronic BB therapy.…”

Section: Discussionmentioning

confidence: 99%

“…Interestingly, there seems to be an interaction between the adrenergic and opioidergic system in the form of a cross-talk between both G-protein coupled receptors [ 8 ]. Moreover, there have been some meta-analyses showing perioperative opioid sparing effects of a short-term treatment of the short-acting BB Esmolol [ 9 – 11 ]. Its application resulted in a reduced postoperative pain intensity and postoperative nausea and vomiting (PONV) [ 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

“…Moreover, there have been some meta-analyses showing perioperative opioid sparing effects of a short-term treatment of the short-acting BB Esmolol [ 9 – 11 ]. Its application resulted in a reduced postoperative pain intensity and postoperative nausea and vomiting (PONV) [ 10 , 11 ]. In contrast, there is currently little understanding of the impact of a long-term “chronic” BB therapy on perioperative opioid use.…”

Section: Introductionmentioning

confidence: 99%

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Influence of a chronic beta-blocker therapy on perioperative opioid consumption – a post hoc secondary analysis

Trauzeddel,

Rothe,

Nordine

et al. 2024

BMC Anesthesiol

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Background Beta-blocker (BB) therapy plays a central role in the treatment of cardiovascular diseases. An increasing number of patients with cardiovascular diseases undergoe noncardiac surgery, where opioids are an integral part of the anesthesiological management. There is evidence to suggest that short-term intravenous BB therapy may influence perioperative opioid requirements due to an assumed cross-talk between G-protein coupled beta-adrenergic and opioid receptors. Whether chronic BB therapy could also have an influence on perioperative opioid requirements is unclear. Methods A post hoc analysis of prospectively collected data from a multicenter observational (BioCog) study was performed. Inclusion criteria consisted of elderly patients (≥ 65 years) undergoing elective noncardiac surgery as well as total intravenous general anesthesia without the use of regional anesthesia and duration of anesthesia ≥ 60 min. Two groups were defined: patients with and without BB in their regular preopreative medication. The administered opioids were converted to their respective morphine equivalent doses. Multiple regression analysis was performed using the morphine-index to identify independent predictors. Results A total of 747 patients were included in the BioCog study in the study center Berlin. 106 patients fulfilled the inclusion criteria. Of these, 37 were on chronic BB. The latter were preoperatively significantly more likely to have arterial hypertension (94.6%), chronic renal failure (27%) and hyperlipoproteinemia (51.4%) compared to patients without BB. Both groups did not differ in terms of cumulative perioperative morphine equivalent dose (230.9 (BB group) vs. 214.8 mg (Non-BB group)). Predictive factors for increased morphine-index were older age, male sex, longer duration of anesthesia and surgery of the trunk. In a model with logarithmised morphine index, only gender (female) and duration of anesthesia remained predictive factors. Conclusions Chronic BB therapy was not associated with a reduced perioperative opioid consumption. Trial registration This study was registered at ClinicalTrials.gov (NCT02265263) on the 15.10.2014 with the principal investigator being Univ.-Prof. Dr. med. Claudia Spies.

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“…[8,9] Generally, ramosetron is used for the prevention of PONV, while esmolol can help in preventing PONV by providing patient hemodynamic stability during surgeries. [7,8,10,11] In previous studies, various antiemetics have been used in combination to reduce PONV. [12] However, there have been no reports on the effect of the combined use of ramosetron and esmolol on PONV.…”

Section: Introductionmentioning

confidence: 99%

Comparing the effects of continuous infusion of esmolol and ramosetron alone and in combination on nausea and vomiting after laparoscopic cholecystectomy: A prospective, randomized, double-blind study

Kim

Seo

et al. 2022

Medicine

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Background: Postoperative nausea and vomiting (PONV) is a common complication of laparoscopic cholecystectomy. Although PONV is usually mild, severe thing can delay recovery and prolong hospitalization. We aimed to investigate the effects of ramosetron and esmolol, alone and in combination, on PONV, and pain. Methods: We enrolled 165 patients in their 20s to 50s who had an American Society of Anesthesiology physical status score of 1 or 2 and were scheduled to undergo laparoscopic cholecystectomy. They were randomly allocated into 3 groups: groups R, E, and E+R. Patients in group R received 0.3 mg of ramosetron following surgery. Those in group E were intravenously administered a bolus of esmolol (1.0 mg/kg) before endotracheal intubation. They were continuously infused with esmolol during the surgery to maintain their heart rate at 60 to 100 beats per minute and mean blood pressure at 60 to 100 mm Hg, followed by a bolus of esmolol (1.0 mg/kg) following surgery. Patients in group E+R were intravenously administered a bolus of esmolol (1.0 mg/kg) before endotracheal intubation, infused esmolol during surgery, and administered 0.3 mg of ramosetron and a bolus of esmolol (1.0 mg/kg) following surgery. We monitored the PONV stages (none, nausea, retching, and vomiting) and symptom severity in 3 postoperative stages (0–30 minutes, 30 minutes to 6 hours, and 6–24 hours), the latter by using the visual analog scale (VAS). We conducted an analysis of variance to compare VAS scores between groups. Results: Patients in groups E (mean ± standard deviation VAS score, 3.62 ± 1.00) and E+R (3.66 ± 0.71) exhibited less pain (P < .05) until 30 minutes following surgery compared to group R (5.72 ± 1.41). More patients in group E (28/50, 56%) experienced nausea compared to those in groups R (15/50, 30%) and E+R (8/50, 16%) until 30 minutes after surgery (P < .05). However, there were no differences in the severity of retching and vomiting between the groups in any of the phases (P > .05). Conclusion: Despite reducing pain after laparoscopic cholecystectomy, esmolol did not prevent PONV, whether used alone or in combination with ramosetron.

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The effect of esmolol compared to opioids on postoperative nausea and vomiting, postanesthesia care unit discharge time, and analgesia in noncardiac surgery: A meta-analysis

Cited by 15 publications

References 29 publications

Intra-operative esmolol and pain following mastectomy

Intra-operative esmolol and pain following mastectomy

Influence of a chronic beta-blocker therapy on perioperative opioid consumption – a post hoc secondary analysis

Comparing the effects of continuous infusion of esmolol and ramosetron alone and in combination on nausea and vomiting after laparoscopic cholecystectomy: A prospective, randomized, double-blind study

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