RESUMO
BACKGROUND AND AIMS: Perioperative esmolol as an opioid alternative has been shown to reduce postoperative nausea vomiting using opioid sparing. The aim of this meta-analysis was to compare esmolol and opioids on postoperative nausea and vomiting (PONV), time spent in recovery, and analgesia in noncardiac surgeries. MATERIAL AND METHODS: OVID Medline (1980-February 2014), OVID EMBASE, EBSCO, CINAHL, and the Cochrane Register of Controlled Trials were searched for randomized controlled trials (RCTs) comparing esmolol and opioids on early postoperative recovery and pain intensity during general anesthesia in noncardiac surgeries. The primary outcomes were related to PONV and postanesthesia care unit (PACU) discharge time, whereas secondary outcomes were related to early postoperative pain. RESULTS: Eight trials were identified involving 439 patients, 228 of whom received esmolol while 211 received opioids. A random-effects meta-analysis showed that in comparison with opioids, esmolol led to a 69% reduction in the incidence of PONV (odds ratio 0.31, 95% confidence interval [CI] 0.13-0.74, P = 0.008, I2 = 44.1%). An increase in the volatile anesthetic requirement was evident in the esmolol group compared with opioid (MD + 0.67% desflurane equivalent, 95% CI 0.27-1.08, P = 0.001, I2 =23.5%). There was no statistically significant difference between the esmolol and opioid groups in relation to PACU discharge time, early postoperative pain scores, opioid requirement, and cumulative opioid consumption. Significant heterogeneity was noted between studies. No significant adverse effects were noted. CONCLUSION: Compared with opioids, perioperative esmolol may reduce the incidence of postoperative nausea vomiting and increase the volatile anesthetic requirement. Esmolol administration may not improve the early postoperaive pain intensity. Nonetheless, these findings are limited by the absence of high-quality RCTs and the heterogeneity among studies. Further, large-scale studies are needed to explore these results.
RESUMO
Esmolol has been shown to improve postoperative pain and reduce opioid requirements. The aim of this systematic review was to evaluate the effect of perioperative esmolol as an adjunct on early postoperative pain intensity, recovery profile, and anesthetic requirement. Databases were searched for randomized placebo-controlled trials evaluating the effects of esmolol during general anesthesia. Primary outcomes were related to early postoperative pain whereas secondary outcomes were related to emergence time, postoperative nausea and vomiting, and intraoperative anesthetic requirement. Nineteen trials were identified involving 936 patients (esmolol = 470, placebo = 466). In esmolol group, numeric pain scores at rest in the immediate postoperative period were reduced by 1.16 (95% confidence interval [CI]: 1.97-0.35, I2 = 96.7%) out of 10. Opioid consumption was also decreased in the postanesthesia care unit compared with placebo, mean difference of 5.1 mg (95% CI: 7.0-3.2, I2 = 96.9%) morphine IV equivalents; a 69% reduction in opioid rescue dosing was noted (odds ratio [OR]: 0.31, 95% CI: 0.16-0.80, I2 = 0.0%). A 61% reduction in postoperative nausea and vomiting was also evident (OR: 0.39, 95% CI: 0.20-0.75, I2 = 60.7%). A reduction in propofol induction dose was noted in the esmolol group (mean difference: -0.53 mg/kg, 95% CI: -0.63--0.44, I2 = 0.0%). A decrease in end-tidal desflurane equivalent (mean difference: 1.70%, 95% CI: -2.39--1.02, I2 = 92.0%) and intraoperative opioid usage (fentanyl equivalent, mean difference: 440 µg, 95% CI: -637--244, I2 = 99.6%) was observed in esmolol group. Esmolol had no effect on the emergence time. Perioperative esmolol as an adjunct may reduce postoperative pain intensity, opioid consumption, and postoperative nausea vomiting. Given the heterogeneity, larger clinical trials are warranted to confirm these findings.
