Effect of Different Concentrations of Esmolol on Perioperative Hemodynamics and Analgesia in Patients Undergoing Colectomy: A Prospective, Randomized Controlled Study

Abstract

Purpose

The aim of this study was to investigate the efficacy of esmolol on intraoperative hemodynamic and perioperative analgesic management.

Methods

Totally, 125 patients undergoing colectomy were randomly divided into three groups. Group S (saline group) was administered 0.75 mL/kg/h of normal saline for 5 min before anesthesia induction and maintenance of 0.25 mL/kg/h; Group E₁ and Group E₂ were administered 0.5 mg/kg and 1.0 mg/kg esmolol for 5 min before anesthesia induction, and maintained of 0.5 mg/kg/h and 2.0 mg/kg/h, respectively. Several parameters including indexes of hemodynamics variation (primary outcome), intra- and postoperative analgesic usage, and pain score were measured.

Results

Group E₁ and Group E₂ had significantly lower intubation response than Group S (P = 0.007, P = 0.001), and extubation response of Group E₂ was significantly lower than Group S (P = 0.007). The opioid consumption in Group E₁ and Group E₂ was significantly lower than in Group S intraoperatively (P = 0.020 and 0.007). The incidence of postoperative adverse reactions among the three groups was not statistically significant (P = 0.368 and 0.772).

Conclusion

Esmolol 0.5 mg/kg and 1.0 mg/kg infusion before intubation both can effectively inhibit the intubation response, while only maintenance with 2.0 mg/kg/h of esmolol can reduce the incidence of extubation response. At the same time, esmolol can decrease intraoperative opioid requirement without increasing the risk of adverse reactions.

Trial Registration

ChiCTR1900024538 and the date of registration was July 15, 2019 at http://www.chictr.org.cn.

Keywords:

• esmolol
• hemodynamics
• analgesia
• intubation response
• extubation response

Acknowledgments

The authors gratefully thank Santosh Kumar Paidi from Johns Hopkins University, USA, for useful comments, suggestions and language editing for improving the manuscript. Chao Zheng acknowledges support from the Taishan Scholars Program of Shandong Province (tsqn201812135). We would like to thank all participants involved in the study for their cooperation.

Abbreviations

ANOVA, analysis of variance; ASA, American Society of Anesthesiologists; BMI, body mass index; COPD, chronic obstructive pulmonary disease; ERAS, enhanced recovery after surgery; FESS, functional endoscopic sinus surgery; HPA(HTPA), hypothalamic–pituitary–adrenal; HR, heart rate; LSD, least significant difference; MAP, mean arterial pressure; NCSS, number crunching statistical system; NRS, numerical rating scale; PACU, postanesthesia care unit; PASS, power analysis and sample size; PCA, patient-controlled analgesia; PONV, post-operative nausea and vomiting; QLB, quadratus lumborum block; SPSS, statistical program for social sciences; TAPB, abdominis plane block; US-QLB, ultrasound-guided quadratus lumborum block.

Data Sharing Statement

All data generated or analyzed during this study were included in this published article. Further inquiries can be directed to Professor Xin Zhao on reasonable request.

Ethics Approval and Consent to Participate

This study was approved by the Ethics Committee of the Second Hospital of Shandong University with the approval number KYLL-2019(LW)009 on June 10, 2019, and in accordance with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was prospectively registered at http://www.chictr.org.cn on July 15, 2019, identifier ChiCTR1900024538. Informed consent was obtained from all of the participants.

Consent for Publication

All authors have read the manuscript, attest to the validity and legitimacy of the data and its interpretation, and agree to its publication.

Disclosure

The authors declare that they have no competing interests.