Esmolol as an Intraoperative Pain Adjunct in Adult Populations: An Integrative Literature Review

Lisa Nguyen, RN, DNP, CRNA

DNP Nurse Anesthesia 

Esmolol as an Intraoperative Pain Adjunct in Adult Populations: An Integrative Literature Review

Project Category: Evidence Synthesis 

Project Team: Lisa Nguyen, DNP, CRNA Chloe Knox, DNP, CRNA Michael Ledvina, DNP, CRNA (Advisor) 

Abstract

Background: Unrelieved postoperative pain is one of the biggest predictors for the development of chronic pain. The use of esmolol as a multimodal pain adjunct has previous research that both support and refute its efficacy in reducing analgesic consumption and postoperative pain scores with fewer side effects than opioid analgesics.  

Methods: An integrative review was undertaken using a systematic search of four databases, limited to the last six years. A total of 12 studies with 941 patients were included in this integrative review. Studies were appraised for methodological bias by two reviewers. Primary findings focused on postoperative pain scores measured by visual analog scale or numeric rating scale and total analgesic consumption using morphine and morphine equivalents. Secondary outcomes such as effects of esmolol on hemodynamic changes, postoperative nausea and vomiting, hospital length of stay and inhalation anesthetic requirements were also assessed. Results were extracted and presented in tabular and graphical formats to show average comparisons. 

Results: Overall, nine out of 12 of the studies indicated that there was a statistically significant difference between pain scores, while eight out of ten studies showed statistical significance in analgesic consumption for patients receiving esmolol. Doses of esmolol administered ranged from 0.5 - 1.5 mg/kg bolus followed by an infusion between 5 - 100 mcg/kg/min.

Conclusion: The recommended dose of esmolol to decrease postoperative pain scores and analgesic consumption is a 0.5 mg/kg bolus prior to induction, followed by a continuous infusion of 5 - 15 mcg/kg/min titrated to hemodynamic stability. However, clinicians should base their decision by considering the surgical procedure and specific patient comorbidities to determine if adult patients would benefit from using esmolol as an analgesic adjunct.

Full Manuscript Slide Presentation Video