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European Journal of Anaesthesiology:
Abstracts and Programme: EUROANAESTHESIA 2011: The European Anaesthesiology Congress: Evidence-based Practice and Quality Improvement

Esmolol vs epidural anesthesia in bariatric surgery: Pain control and postoperative outcome: 1AP1‐1

Casalino, S.; Fabozzi, M.; Millo, P.; Cena, A.; Angellotti, A.; Albani, A.

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Ospedale Regionale di Aosta U. Parini, Department of Anaesthesiology, Aosta, Italy

Background and Aims: In the last 20 years several scientific works have shown anesthetic sparing effects of beta‐blockers. Epidural anesthesia is effective in the treatment of the postoperative pain after bariatric surgery but it could be technically difficult in the obese patient and it could expose to the risk of epidural hematoma. We have hypothesized that the perioperative pain could be treated by intraoperative infusion of esmolol.

Materials and Methods: From 2008 to 2010 we have submitted to bariatric surgery 100 next patients: 68 patients treated by preoperative epidural anesthesia and 32 treated by intraoperative i.v. esmolol. The primary outcome was the intensity of postoperative pain; the secondary outcomes were: the presence of nausea and vomiting ( PONV ) and the resumption of the peristalsis. The statistical study was performed by SPSS software (version 12.0, SPSS Inc.; Chicago, [II]).

Results and Discussion: The two groups were homogeneous as demografic data, clinical preoperative parameters, comorbidity. The results are shown in table 1.

Table 1
Table 1
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Conclusions: The continuous i.v. infusion of esmolol is effective and safe. The pain at 3rd and 6th hour are equal in the two groups but surprisingly lower at 1st p.o. day in the group treated by esmolol. The PONV is equal in the two groups but the resumption of the peristalsis is less than 1.5 days in esmolol group. Further prospective randomized studies are necessary to confirm our data, which, however, remain encouraging.

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References:

1) Vincent Collard et al.: Intraoperative Esmolol Infusion in the Absence of Opioids Spares Postoperative Fentanyl in Patients Undergoing Ambulatory Laparoscopic Cholecystectomy. Anest & Analg 2007; 105, 5:1255-1262

2) Ruari Orme et al.: Esmolol and Anesthetic Requirement for Loss of Responsiveness During Propofol Anesthesia. Anest & Analg 2002;94, 1:112-116

© 2011 European Society of Anaesthesiology

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