Intraoperative esmolol infusion in the absence of opioids spares postoperative fentanyl in patients undergoing ambulatory laparoscopic cholecystectomy.
BACKGROUND
The use of opioids during ambulatory surgery can delay hospital discharge or cause unexpected hospital admission. Preliminary studies using an intraoperative continuous infusion of esmolol in place of an opioid have inconsistently reported a postoperative opioid-sparing effect. In this study, we compared esmolol versus either intermittent fentanyl or continuous remifentanil on postoperative opioid-sparing, side effects, and time of discharge.


METHODS
Ninety patients (consisting of three groups) were enrolled in this prospective, randomized, and observer-blinded study. The control group (n = 30) received intermittent doses of fentanyl, the esmolol group (n = 30) received a continuous infusion of esmolol (5-15 microg x kg(-1) x min(-1)) and no supplemental opioids during surgery, and the remifentanil group (n = 30) received a continuous infusion of remifentanil (0.1-0.5 mixrog x kg(-1) x min(-1)). General anesthesia was standardized, and adjuvant medications included acetaminophen, ketorolac, local anesthetics in the skin incisions, dexamethasone, and droperidol. Postoperative analgesia included fentanyl.


RESULTS
The amount of fentanyl in the postanesthesia care unit was significantly less in the esmolol group, 91.5 +/- 42.7 microg, compared with the other two groups, remifentanil, 237.8 +/- 54.7 microg, control, 168.1 +/- 96.8 microg (P < 0.0001). The incidence of nausea was more frequent in the control (66.7%) and remifentanil (67.9%) groups compared with the esmolol group (30%) (P < 0.01). The esmolol group reached the White-Song score of 12 of 14 faster than the remifentanil group (P < 0.01), and left the hospital 45-60 min earlier (P < 0.004).


CONCLUSIONS
Intraoperative IV infusion of esmolol contributes to a significant decrease in postoperative administration of fentanyl and ondansetron and facilitates earlier discharge.
Collard
Vincent
V
Department of Anesthesia, Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University Health Centre, Montreal, Quebec, Canada.
Mistraletti
Giovanni
G
Taqi
Ali
A
Asenjo
Juan Francisco
JF
Feldman
Liane S
LS
Fried
Gerald M
GM
Carli
Franco
F
D000328:Adult; D000368:Aged; D000556:Ambulatory Surgical Procedures / Q000379:methods; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D017081:Cholecystectomy, Laparoscopic / Q000379:methods; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage*; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000517:prevention & control*; D011412:Propanolamines / Q000008:administration & dosage*; D011446:Prospective Studies
D000701:Analgesics, Opioid; D011412:Propanolamines; C036604:esmolol; D005283:Fentanyl