• Won-Jung Hwang, Young-Eun Moon, Sun-Jin Cho, and Jaemin Lee.
• Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Banpo-dong 504, Seoul, Korea.
• J Clin Anesth. 2013 Feb 1;25(1):36-41.

Study ObjectiveTo investigate whether a continuous infusion of low-dose esmolol results in an opioid-sparing effect during surgery.DesignRandomized, double-blinded, placebo-controlled clinical comparison study.SettingOperating room of a university hospital.Patients56 ASA physical status 1 and 2 patients, aged 20 to 60 years, undergoing laparoscopic gynecologic surgery of less than two hours' duration.InterventionsThe esmolol group (n = 28) received a 0.5 mg/kg loading dose of esmolol followed by an infusion of esmolol 30 μg/kg/min; the saline group (n = 28) received equivalent volumes of normal saline.MeasurementsThe effect-site concentration of remifentanil (ng/mL) to maintain adequate anesthetic depth before infusion of the study drug (before-concentration) was measured. During infusion of study drug, the effect-site concentration of remifentanil was adjusted every 5 minutes to maintain systolic blood pressure within 15% of baseline and a Bispectral Index value between 50-60. The average of these adjusted concentrations (after-concentration) was measured and compared to the before-concentration. The quality of postoperative recovery was assessed.Main ResultsIn the esmolol group, the after-concentration of remifentanil was decreased by 33.3% compared with the before-concentration. The total dose of remifentanil infused was also lower in the esmolol group (0.09 ± 0.1 vs 0.14 ± 0.03 μg/kg/min; P = 0.031). The esmolol group had lower scores on a pain numerical rating scale and required less fentanyl in the Postanesthesia Care Unit.ConclusionsIntraoperative esmolol infusion decreases both the requirement for remifentanil and postoperative administration of rescue analgesics.Copyright © 2013 Elsevier Inc. All rights reserved.

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