Role of β-blockade in anaesthesia and postoperative pain management after hysterectomy

Abstract

Background. Perioperative use of β-blockers has been advocated as a strategy to prevent cardiac sequelae. This study evaluated the influence of perioperative esmolol administration upon anaesthesia and postoperative pain management amongst patients undergoing hysterectomy. Methods. Ninety-seven ASA I-II patients, undergoing abdominal total hysterectomy, were randomly divided into one of two groups. Patients in the Esmolol group received an i.v. loading dose of esmolol 0.5 mg kg-1 followed by infusion of 0.05 mg kg-1 min-1 before anaesthesia induction. The infusion was documented at the completion of surgery. The Control group received a volume of normal saline. After surgery, all patients were treated with patient-controlled i.v. analgesia (PCA), which was programmed to deliver I mg of morphine on demand for 3 consecutive days. Pain intensity on movement and at rest, sedation score, and side effects were recorded. Results. The two groups were comparable with respect to their characteristics. Patients in the esmolol group received significantly lower end-tidal isoflurane concentrations (1.0 (03) vs 1.4 (0.5)%, respectively; P<0.001) and fentanyl (0.9 (0.2) vs 1.2 (0.5) μg kg-1, respectively; P=0.006) during anaesthesia. They also showed a reduced heart rate and arterial pressure response to tracheal intubation, skin incision, and tracheal extubation. The Esmolol group consumed less PCA morphine in 3 days (37.3 (8.4) vs 54.7 (11.2) mg, respectively; P=0.005). Pain intensity and medication side effects were similar in the two groups. Conclusion. The results suggest that perioperative esmolol administration during anaesthesia reduces the intraoperative use of inhalation anaesthetic and fentanyl, decreases haemodynamic responses, and reduced morphine consumption for the first 3 postoperative days. © The Board of Management and Trustees of the British Journal of Anaesthesia 2004.