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AMBULATORY ANESTHESIOLOGY

Intraoperative Esmolol Infusion in the Absence of Opioids Spares Postoperative Fentanyl in Patients Undergoing Ambulatory Laparoscopic Cholecystectomy

Vincent Collard, MD^*, Giovanni Mistraletti, MD^*, Ali Taqi, MD, Juan Francisco Asenjo, MD^*, Liane S. Feldman, MD, Gerald M. Fried, MD, and Franco Carli, MD, MPhil^*

From the Departments of *Anesthesia and Surgery, Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University Health Centre, Montreal, Quebec, Canada.

Address correspondence and reprint requests to Franco Carli, Department of Anesthesia, McGill University Health Centre, Room D10.144, Montreal, Quebec, Canada. Address e-mail to franco.carli{at}mcgill.ca.

Abstract

BACKGROUND: The use of opioids during ambulatory surgery can delay hospital discharge or cause unexpected hospital admission. Preliminary studies using an intraoperative continuous infusion of esmolol in place of an opioid have inconsistently reported a postoperative opioid-sparing effect. In this study, we compared esmolol versus either intermittent fentanyl or continuous remifentanil on postoperative opioid-sparing, side effects, and time of discharge.

METHODS: Ninety patients (consisting of three groups) were enrolled in this prospective, randomized, and observer-blinded study. The control group (n = 30) received intermittent doses of fentanyl, the esmolol group (n = 30) received a continuous infusion of esmolol (5–15 µg · kg^–1 · min^–1) and no supplemental opioids during surgery, and the remifentanil group (n = 30) received a continuous infusion of remifentanil (0.1–0.5 µg · kg^–1 · min^–1). General anesthesia was standardized, and adjuvant medications included acetaminophen, ketorolac, local anesthetics in the skin incisions, dexamethasone, and droperidol. Postoperative analgesia included fentanyl.

RESULTS: The amount of fentanyl in the postanesthesia care unit was significantly less in the esmolol group, 91.5 ± 42.7 µg, compared with the other two groups, remifentanil, 237.8 ± 54.7 µg, control, 168.1 ± 96.8 µg (P < 0.0001). The incidence of nausea was more frequent in the control (66.7%) and remifentanil (67.9%) groups compared with the esmolol group (30%) (P < 0.01). The esmolol group reached the White-Song score of 12 of 14 faster than the remifentanil group (P < 0.01), and left the hospital 45–60 min earlier (P < 0.004).

CONCLUSIONS: Intraoperative IV infusion of esmolol contributes to a significant decrease in postoperative administration of fentanyl and ondansetron and facilitates earlier discharge.

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