Brazilian Journal of Anesthesiology
Brazilian Journal of Anesthesiology
Scientific Article

Intraoperative esmolol infusion reduces postoperative analgesic consumption and anaesthetic use during septorhinoplasty: a randomized trial

Infusão intraoperatória de esmolol reduz o consumo pós-operatório de analgésicos e o uso de anestésico durante a septorrinoplastia: estudo randômico

Nalan Celebi; Elif A. Cizmeci; Ozgur Canbay

Downloads: 1
Views: 640


Background and objectives:Esmolol is known to have no analgesic activity and no anaesthetic properties; however, it could potentiate the reduction in anaesthetic requirements and reduce postoperative analgesic use. The objective of this study is to evaluate the effect of intravenous esmolol infusion on intraoperative and postoperative analgesic consumptions as well as its effect on depth of anaesthesia.Methods:This randomized-controlled double blind study was conducted in a tertiary care hospital between March and June 2010. Sixty patients undergoing septorhinoplasty were randomized into two groups. History of allergy to drugs used in the study, ischaemic heart disease, heart block, bronchial asthma, hepatic or renal dysfunction, obesity and a history of chronic use of analgesic or β-blockers were considered cause for exclusion from the study. Thirty patients received esmolol and remifentanil (esmolol group) and 30 patients received normal saline and remifentanil (control group) as an intravenous infusion during the procedure. Mean arterial pressure, heart rate, and bispectral index values were recorded every 10min. Total remifentanil consumption, visual analogue scale scores, time to first analgesia and total postoperative morphine consumption were recorded.Results:The total remifentanil consumption, visual analogue scale scores at 0, 20 and 60 min, total morphine consumption, time to first analgesia and the number of patients who needed an intravenous morphine were lower in the esmolol group.Conclusions:Intravenous infusion of esmolol reduced the intraoperative and postoperative analgesic consumption, reduced visual analogue scale scores in the early postoperative period and prolonged the time to first analgesia; however it did not influence the depth of anaesthesia.


Analgesia, Bispectral index, Esmolol, Morphine


Justificativa e objetivos:Esmolol é conhecido por não ter atividade analgésica e propriedades anestésicas; porém, pode potenciar a redução da necessidade de anestésicos e reduzir o uso de analgésicos no pós-operatório. O objetivo deste estudo foi avaliar o efeito da infusão de esmolol por via intravenosa sobre o consumo de analgésico durante os períodos intraoperatório e pós-operatório, bem como seu efeito sobre a profundidade da anestesia.Métodos:Este estudo randômico, controlado e duplo-cego foi conduzido em um hospital terciário entre março e junho de 2010. Foram randomicamente divididos em dois grupos 60 pacientes programados para serem submetidos à septorrinoplastia. História de alergia aos medicamentos usados no estudo, isquemia cardíaca, bloqueio cardíaco, asma brônquica, insuficiência hepática ou renal, obesidade e história de uso crônico de analgésicos ou β-bloqueadores foram os critérios de exclusão. Trinta pacientes receberam esmolol e remifentanil (grupo esmolol) e 30 receberam soro fisiológico e remifentanil (grupo controle) via perfusão intravenosa. Pressão arterial média, frequência cardíaca e valores do índice bispectral foram registrados a cada 10 minutos. Consumo total de remifentanil, escores da escala visual analógica, tempo para a primeira analgesia e consumo total de morfina no pós-operatório foram registrados.Resultados:O consumo total de remifentanil, os escores da escala visual analógica nos minutos 0, 20 e 60, o consumo total de morfina, o tempo para a primeira analgesia e o número de pacientes que precisaram de morfina intravenosa foram menores no grupo esmolol.Conclusões:Esmolol em infusão intravenosa reduziu o consumo de analgésicos tanto no intraoperatório quanto no pós-operatório, reduziu os escores da escala analógica visual no pósoperatório imediato e prolongou o tempo para a primeira analgesia; contudo, não influenciou a profundidade da anestesia.


Analgesia, Índice bispectral, Esmolol, Morfina


Miller DR, Martineau RJ, Wynands JE. Bolus administration of esmolol for controlling the haemodynamic response to tracheal intubation: the Canadian multicentre trial. Can J Anaesth. 1991;38:849-58.

Gold JI, Sacks DJ, Grosnoff DB. Use of esmolol during anesthesia to treat tachycardia and hypertension. Anesth Analg. 1989;68:101-4.

Fuhrman TM, Ewell CL, Pippin WD. Comparison of the efficacy of esmolol and alfentanil to attenuate the hemodynamic response to emergence and extubation. J Clin Anesth. 1992;4:444-7.

Angaran DM, Schultz NJ, Tschida VH. Esmolol hydrochloride: an ultrashort-acting, beta-adrenergic blocking agent. Clin Pharm. 1986;5:288-303.

Johansen JW, Flashion R, Sebel PS. Esmolol reduces anesthetic requirement for skin incision, during propofol/nitrous oxide/morphine anesthesia. Anesthesiology. 1999;91:1674-86.

Johansen JW, Schneider G, Windsor AM. Esmolol potentiates reduction of minimal alveolar isoflurane concentration by alfentanil. Anesth Analg. 1998;87:671-6.

Chia YY, Chan MH, Ko NH. Role of β-blockade in anaesthesia and postoperative pain management after hysterectomy. Br J Anaesth. 2004;93:799-805.

Davidson EM, Szmuk P, Doursout MF. Antinociceptive properties of labetolol in the rat formalin test. Anesthesiology. 1998;89:S1091.

Davidson EM, Doursout MF, Szmuk P. Antinociceptive and cardiovascular properties of esmolol following formalin injection in rats. Can J Anesth. 2001;48:59-64.

Newfield P, Cottrell JE. Handbook of neuroanaesthesia. 2003:39.

Zaugg M, Tagliente T, Lucchinetti E. Beneficial effects from β-adrenergic blockade in elderly patients undergoing non-cardiac surgery. Anesthesiology. 1999;93:209-18.

Mitrovic I, Margeta-Mitrovic M, Bader S. Contribution of GIRK2-mediated postsynaptic signaling to opiate and alpha 2-adrenergic analgesia and analgesic sex differences. Proc Natl Acad Sci USA. 2003;100:271-6.

Hageluken A, Naurnberg B, Harhammer R. Lipophilic beta-adrenoreceptor antagonists are effective direct activators of G-proteins. Biochem Pharmacol. 1994;47:1789-95.

Johansen JW, Sebel PS. Possible interaction of esmolol and nitrous oxide. Anesthesiology. 1997;87:461-2.

Vucevic M, Purdy GM, Ellis FR. Esmolol hydrochloride for management of the cardiovascular stress response to laryngoscopy and tracheal intubation. Br J Anaesth. 1992;68:529-30.

Coloma M, Chiu JW, White PF. The use of esmolol as an alternative to remifentanil during desflurane anesthesia for fast-tract outpatient gynecologic laparoscopic surgery. Anesth Analg. 2001;92:352-7.

Ebert TJ, Bernstein JS, Stowe DF. Attenuation of hemodynamic responses to rapid sequence induction and intubation in healthy patients with a single dose of esmolol. J Clin Anesth. 1990;2:243-52.

Parnass SM, Rothenberg DM, Kerchberger JP. A single bolus dose of esmolol in the prevention of intubation-induced tachycardia and hypertension in an ambulatory surgery unit. J Clin Anesth. 1990;2:232-7.

Iselin Chaves IA, Flaishon R, Sebel PS. The effect of the interaction of propofol and alfentanil on recall, loss of consciousness and bispectral index. Anesth Analg. 1998;87:949-55.

Guignard B, Menigaux C, DuPont X. The effect of remifentanil on the bispectral index change and hemodynamic responses after orotracheal intubation. Anesth Analg. 2000;90:161-7.

Johansen JW. Esmolol promotes electroencephalographic burst suppression during propofol/alfentanil anaesthesia. Anest Analg. 2001;93:1526-31.

Menigaux C, Guignard B, Adam F. Esmolol prevents movement and attenuates the BIS response to orotracheal intubation. Br J Anaesth. 2002;89:857-62.

Stanley TH, De lange S, Boscoe MJ. The influence of propranolol therapy on cardiovascular dynamics and narcotic requirements during operation in patients with coronary artery disease. Can Anaesth Soc. 1982;29:319-24.

5dcd92320e8825d729bf58f2 rba Articles
Links & Downloads

Braz J Anesthesiol

Share this page
Page Sections