| Background: Opioid analgesics continue to be the treatment of choice for managing acute pain in the perioperative phase despite prevalent complications including respiratory depression, postoperative nausea and vomiting (PONV) and opioid induced hyperalgesia. Previous research has shown that the use of esmolol as an adjunct medication in laparoscopic surgeries can decrease opioid and anesthetic requirements, reduce the incidence of PONV, shorten discharge times, and increase patient satisfaction. The purpose of the study is to investigate the effect of the intraoperative administration of esmolol on patients undergoing arthroscopic shoulder surgery with a continuous low volume brachial plexus nerve block on opioid requirements in the post anesthesia care unit (PACU).;Methods: A retrospective chart review of 314 medical records was conducted on patients who underwent arthroscopic shoulder surgery at Phelps County Regional Medical Center (PCRMC) from November 2015 through December 2016. Patients who met the inclusion criteria were divided into two groups. Group A participants received esmolol 0.5 mg/kg prior to induction and did not receive fentanyl or fentanyl derivatives intraoperatively. Group B participants received fentanyl and fentanyl derivatives intraoperatively and were not given esmolol. Opioid consumption for each patient was measured in the PACU and converted into morphine equivalents (ME) to allow for comparisons between groups.;Results: Data from 176 patient charts met the inclusion criteria and were analyzed. The mean opioid consumption in the PACU for the emolol group (n=88) was 9.59 mg compared to 7.57 mg in the control group (n=88) (P>0.05). Secondary findings showed that the esmolol group had a statistically significant decreased length of stay in the PACU (130.75 min versus 148.85 min, P>0.05), and reduced unanticipated hospital admissions (2.27% versus 11.36%, P<0.05), lower incidence of 30-day emergency room visits (3.41% versus 12.5%, P<0.05) and less total perioperative ME (11.07 mg versus 27.13 mg, P<0.05).;Conclusion: Patients who received esmolol intraoperatively instead of fentanyl or fentanyl derivatives did not require more opioids in the PACU. Additionally, these patients had a decreased length of stay in the PACU, reduced unanticipated hospital admissions, lower 30-day emergency room visits and less total perioperative ME. |
