The efficacy of esmolol and nitroglycerine in creating dry operative field by producing controlled hypotension in spinal surgeries.

Abstract

Introduction: Laminectomy and Spine Surgeries are associated with increased blood loss due to bleeding from the extensive epidural venous plexuses. Controlled hypotension is a time tested technique utilized for reducing blood loss and creating a blood less operative field. Esmolol and Nitroglycerine(NTG) are reportedly used in various surgeries for this purpose. As dry operative field is a fundamental component of spine surgeries this study intended to compare the dry operative field created by esmolol with NTG. Material and Methods: This single blinded randomized controlled trial was carried out on 50 adult patients undergoing spine surgeries and divided into two groups of 25 each. Group-E received Esmolol infusion while the Group-N received NTG infusion.Dosages were titrated to achieve controlled hypotension and optimum bloodless operative field. Results: Systoloic, Diastolic and Mean arterial pressures were comparable in both the groups.Pulse rates in group-E were significantly lower(P<0.05) as compared to that in group-N.Mean scores for quality of surgical field were comparable in both the groups however group E required lower blood pressures to achieve it compared to group-N. Esmolol infusion required significantly higher cost than NTG for the above trial. Conclusion: Both Esmolol and NTG can be used as a sole agent to create dry operative field in spine surgeries by way of controlled hypotension with comparable efficacy however NTG is more economical than esmolol for this purpose. Also dry operative field with NTG can be achieved at higher mean blood pressure values compared with use of esmolol.