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

Background. Perioperative use of ß-blockers has beenadvocated as a strategy to prevent cardiac sequelae. This studyevaluated the influence of perioperative esmolol administrationupon anaesthesia and postoperative pain management amongst patientsundergoing hysterectomy. Methods. Ninety-seven ASA I–II patients, undergoing abdominaltotal hysterectomy, were randomly divided into one of two groups.Patients in the Esmolol group received an i.v. loading doseof esmolol 0.5 mg kg^–1 followed by infusion of 0.05 mgkg^–1 min^–1 before anaesthesia induction. The infusionwas documented at the completion of surgery. The Control groupreceived a volume of normal saline. After surgery, all patientswere treated with patient-controlled i.v. analgesia (PCA), whichwas programmed to deliver 1 mg of morphine on demand for 3 consecutivedays. Pain intensity on movement and at rest, sedation score,and side effects were recorded. Results. The two groups were comparable with respect to theircharacteristics. Patients in the esmolol group received significantlylower end-tidal isoflurane concentrations (1.0 (0.3) vs 1.4(0.5)%, respectively; P<0.001) and fentanyl (0.9 (0.2) vs1.2 (0.5) µg kg^–1, respectively; P=0.006) duringanaesthesia. They also showed a reduced heart rate and arterialpressure response to tracheal intubation, skin incision, andtracheal extubation. The Esmolol group consumed less PCA morphinein 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 thetwo groups. Conclusion. The results suggest that perioperative esmolol administrationduring anaesthesia reduces the intraoperative use of inhalationanaesthetic and fentanyl, decreases haemodynamic responses,and reduced morphine consumption for the first 3 postoperativedays.