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. |
