Does esmolol infusion have an adjuvant effect on transversus abdominis plane block for pain control in laparoscopic cholecystectomy? A randomized controlled double-blind trial

Abstract

Background: Both intraoperative esmolol and transversus abdominis plane (TAP) block facilitate postoperative analgesia after laparoscopic cholecystectomy as part of multimodal analgesia. Both strategies can minimize the use of postoperative opioids. In current study, our goal was to assess if intra-operative esmolol infusion in association with TAP block can overcome the deficits of TAP block alone after laparoscopic cholecystectomy. Methods: This prospective, randomized and double-blinded clinical trial included 60 patients of either sex who scheduled for elective laparoscopic cholecystectomy; received either ultrasound-guided TAP block alone or in association with intravenous esmolol bolus (0.5 mg/kg) before induction followed by a maintenance infusion (0.05 mg/kg/min) till the end of operation. Intra-operative hemodynamic parameters were followed up. Postoperatively, in order to maintain visual analogue scale (VAS) scores ≤3, patients received IV morphine. The primary outcome was amount of opioid consumption during the first 24 hours postoperative. Pain scores, mean arterial pressure (MAP), heart rate (HR) and occurrence of nausea/vomiting were secondary outcomes. Results: The mean morphine consumption after surgery in patients receiving esmolol was (5.83) mg compared to (7.5) mg in TAP only group (p = 0.204). The mean pain scores at early postoperative hours were significantly lower in esmolol group (p < 0.05). MAP and HR were significantly lower in esmolol group intraoperative; however, no variance was detected later. Conclusion: In the first 24 hours following surgery, esmolol infusion increased the analgesic impact of TAP block in terms of opioid demand and pain severity.