In a meta-analysis published in Anesthesia & Analgesia, esmolol was shown to reduce the use of opioids during and after surgery without having a significant impact on postoperative pain scores.

To evaluate the impact of intraoperative esmolol on opioid use and pain scores, researchers included randomized placebo-controlled, or opioid-controlled studies of intraoperative esmolol in this systematic review and meta-analysis. A total of 23 studies were included in the review, and 19 studies were analyzed for comparison. Opioid use was compared intraoperatively and postoperatively in the postanesthesia care unit. Pain scores were compared within 1 hour of surgery.

In 433 participants from 7 studies, intraoperative esmolol was associated with reduced intraoperative opioid use (standard mean difference [SMD], -1.60; P <.001). In a similar manner, in 649 participants from 12 studies, intraoperative esmolol reduced opioid use following surgery (SMD, –1.21; P <.001).

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Intraoperative opioid use and postanesthesia control unit opioid use were both reduced when esmolol vs opioid was used intraoperatively. No significant difference in pain scores was noted in participants who received intraoperative esmolol compared with other options (SMD, –0.60; P =.163).

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In a discussion of their results, the study authors explained that “both qualitative and quantitative analyses demonstrate potential benefits and minimal side effects of intraoperative esmolol, warranting further investigation.”

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Gelineau AM, King MR, Ladha KS, Burns SM, Houle T, Anderson TA. Intraoperative esmolol as an adjunct for perioperative opioid and postoperative pain reduction: A systematic review, meta-analysis, and meta-regression [published online October 11, 2017]. Anesth Analg. doi: 10.1213/ANE.0000000000002469