The effect of perioperative esmolol infusion on the postoperative nausea, vomiting and pain after laparoscopic appendectomy

Abstract

BackgroundPerioperative opioid administration results in postoperative nausea and vomiting (PONV) and acute opioid tolerance that manifests in increased postoperative pain. Esmolol is an ultra short acting cardioselective β1-adrenergic receptor antagonist, and it has been successfully used for perioperative sympatholysis and it reduces the opioid requirement during total intravenous anesthesia. We tested the hypothesis that perioperative esmolol administration results in decreased PONV and postoperative pain.MethodsSixty patients undergoing laparoscopic appendectomy were randomly assigned to two groups (Group E and Group C). The Group E patients were administered 5-10 µg/kg/min esmolol with remifentanil that was titrated to the autonomic response. The Group C patients received normal saline that was of the same volume as the esmolol in Group E, and the remifentanil was also titrated to the vital sign. Before intubation and extubation, the Group E patients were administered 1.0 mg/kg esmolol, and the Group C patients were administered normal saline of the same volume. The incidence and severity of PONV, the pain score, the rescue antiemetics and the rescue analgesics were assessed 30 min, 6 h and 24 h after surgery. The mean arterial pressure and heart rate under anesthesia were also recorded.ResultsPONV and postoperative pain were significantly increased in Group C. These patients needed more antiemetics and analgesics in the first 24 postoperative hours. The mean arterial pressure and heart rate were significantly higher in Group C at the time of intubation and extubation.ConclusionsPerioperative esmolol administration contributes to the significant decrease in PONV and postoperative pain, and so this facilitates earlier discharge.

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

“…Another study that was mentioned in the meta-analysis found similar results after laparoscopic appendectomy, in that patients received less total remifentanil when they were also given an esmolol infusion, compared with patients receiving only remifentanil. 26 This latter study's opioidsparing effect was also associated with reduction of both postoperative nausea/vomiting and postoperative pain. 26 However, it should be noted that the decreased remifentanil administration in both studies may have resulted from a blunted sympathetic hemodynamic response (ie, tachycardia) after esmolol administration.…”

Perioperative Management of Elderly Patients

“…51,52 Although not frequently considered to augment pain control, esmolol infusions have also been demonstrated to decrease opioid usage in the postoperative period. 53,54 …”

Postoperative Nausea and Vomiting in Cancer Surgery: Present Views on the Solution of the Old Problem

“…В анесте зиологичекой практике наибольшей популярностью, в силу короткого действия и хорошей управлемости эффектом, поль зуется эсмолол. Механизм антиэметогенных влияний эсмоло ла пока точно не определен, однако в исследованиях показано, что применение инфузии эсмолола во время анестезии вплоть до экстубации снижает частоту ПОТР [56,57]. Предположи тельно противорвотную активность препарата связывают с на личием у него антиноцицептивных свойств или способности снижать развивающуюся интраоперационно толерантность к опиоидным анальгетикам, что позволяет уменьшить дозы опи оидов как во время операции, так и в послеоперационном пе риоде.…”

“…Предположи тельно противорвотную активность препарата связывают с на личием у него антиноцицептивных свойств или способности снижать развивающуюся интраоперационно толерантность к опиоидным анальгетикам, что позволяет уменьшить дозы опи оидов как во время операции, так и в послеоперационном пе риоде. [56,57]. Таким образом, представляет интерес определе ние места β 1 адреноблокаторов короткого действия в схемах профилактики ПОТР.…”