THE EFFECT OF INTRAOPERATIVE CONTINUOUS INFUSION OF ESMOLOL ON PAIN REDUCTION, VOMITING AND HEMODYNAMICS STABILITY POSTOPERATIVE ON LAPAROSCOPIC CHOLECYSTECTOMY PATIENTS
Date
2022-01-19
Authors
Bast, Ahmad
Journal Title
Journal ISSN
Volume Title
Publisher
جامعة النجاح الوطنية
Abstract
Background: Alleviation of postoperative pain often requires administration of potent analgesics like opioids. Reduction of opioid analgesic doses, incidence, frequency, and intensity of postoperative pain can improve patient outcomes.
Objective: This study was conducted to assess the effects of continuous intraoperative infusion of esmolol on reducing postoperative pain among patients who underwent laparoscopic cholecystectomy under general anesthesia. The study also assessed the effects of continuous intraoperative infusion of esmolol on reducing nausea and vomiting among the included patients. also the associations between demographic characteristics of the patients and the effects of continuous intraoperative infusion of esmolol on reducing postoperative pain, duration of the laparoscopic cholecystectomy operation, and degree of postoperative pain were also investigated.
Methods: This study was conducted using a double-blind randomized controlled clinical trial design. Patients in both control and intervention groups were adults (>18 years old) who were recruited from Rafedia hospital. Patients in the intervention group started on continuous intraoperative infusion of 5-10mcg/kg/min esmolol until the completion of surgery. In the control group, patients received n/s0.9% at same rate. Postoperative pain was measured by visual analogue scale (VAS). Demographic and hemodynamic variables of the patients were collected on an assessment sheet that was developed for this study.
Results: A total of 65 patients were randomly allocated into control (n = 36) and intervention (n = 29) groups. There were no statistical differences in the demographic data and preoperative hemodynamic variables of the patients in both groups before the intervention was administered. In this study, esmolol continuous intraoperative infusion was shown to maintain PACU hemodynamic parameters and significantly reduced postoperative pain (up to 1 hour postoperatively) among patients who underwent laparoscopic cholecystectomy. The average time to require the first dose of rescue analgesia was longer in the esmolol group compared to the control group. However, this difference was not statistically significant.
Conclusion: Postoperative pain continues to present a heavy burden on patients who undergo surgical interventions, notably, laparoscopic cholecystectomy. In conclusion, continuous intraoperative infusion of esmolol during maintenance anesthesia of patients undergoing laparoscopic cholecystectomy was shown to significantly reduce postoperative pain without destabilizing the hemodynamic parameters. Furthermore, rescue analgesia was less frequently needed in the esmolol group, nausea and vomiting were not reduced by esmolol and are still a major concern. Results of this study might be used to improve future perioperative care of patients scheduled for laparoscopic cholecystectomies.
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Keywords
Analgesia, esmolol, laparoscopic cholecystectomy, opioid sparing, postoperative pain, recovery