The effect of esmolol infusion as an adjunct to total intravenous anesthesia on the total anesthetic and analgesic requirements in arthroscopic shoulder surgery

Abstract

Background Esmolol is the first intravenous, short-acting, titratable b-blocker for use in critical care and surgical settings. It influences core components of an anesthetic regimen, such as analgesia, hypnosis, and memory function . Aims To investigate whether perioperative esmolol infusion as an adjuvant to total intravenous anesthesia could affect the total anesthetic and analgesic requirements in adult patients undergoing arthroscopic shoulder surgery. Settings and design A randomized, double-blinded, prospective study. Materials and methods Eighty adult ASA I and II patients scheduled for elective arthroscopic rotator cuff repair were randomized into the esmolol group ( n = 40) and the control group ( n = 40). In the esmolol group, 1 mg/kg esmolol was given as a bolus over 30 s, followed by 15 mg/kg/min as an intravenous infusion, and in the control group, the same volume of normal saline was given during the same time period. The heart rate, the mean arterial blood pressure, the depth of anesthesia, the duration of anesthesia, the recovery time, total anesthetic requirements, the postoperative pain score (VAS), and the total postoperative analgesic requirements were monitored and calculated during the perioperative period. Results There was no significant difference between both groups regarding the demographic data using the unpaired t -test. There was a significant difference between both groups ( P t -test. Preoperative mean values of heart rate (beats/min) and the mean arterial blood pressure (mmHg) were comparable between the two groups ( P > 0.05). However, after induction of anesthesia and thereafter, there was a significant reduction in heart rate and mean arterial blood pressure mean values in the esmolol group when compared with the control group ( P t -test. However, there was no significant difference between both groups. Postoperative pain assessments by VAS (0-100 mm) showed significantly lower pain scores in the esmolol group compared with the control group by the paired t -test ( P P < 0.001) in the total cumulative doses of morphine consumption by PCA during the first 24 h in the esmolol group compared with the control group. Conclusion Perioperative esmolol infusion reduces the total anesthetic and analgesic requirements and postoperative pain. Hence, esmolol can be considered as safe and suitable adjuvant to total intravenous anesthesia.