Esmolol, an ultra-short acting β-blocker, given intravenously, provides a rapid onset effect, but of short duration action. It gives an unexampled level of tolerability and safety in the perioperative setting.

Esmolol has been found to improve postoperative pain and reduce opioid requirements. This systematic review and meta-analysis were performed to evaluate the effect of perioperative esmolol as an adjunct on early postoperative pain intensity, recovery profile, and anaesthetic requirement. For this database of randomized placebo-controlled comparative trials evaluating the effects of esmolol during general anaesthesia in all types of surgery were reviewed.

It was searched in OVID MEDLINE (1980–February 2014), OVID EMBASE, EBSCO, CINAHL, and the Cochrane Register. This review studied 19 trials that involved 936 patients, divided into two groups (esmolol = 470, placebo = 466). Inclusion criteria were based on that the fact that at least one patient outcome or anaesthetic variables such as pain scores, intraoperative and postoperative opioid consumption, emergence time, PONV, and an anaesthetic requirement was reported, were included in the meta-analysis.

The primary outcomes were like acute postoperative pain scores at rest, cumulative opioid consumption, and rescue analgesic administration. The secondary outcomes were associated with emergence time, postoperative nausea and vomiting, and intraoperative anaesthetic requirement.

In results, Esmolol group showed reduction by 1.16 in the numeric pain scores at rest in the immediate postoperative period (95% confidence interval [CI]: 1.97–0.35, I2 = 96.7%) out of 10.  Also decrease in the opioid consumption in the post anesthesia care unit compared with placebo, mean difference of 5.1 mg (95% CI: 7.0–3.2, I2 = 96.9%) morphine IV equivalents; Reduction in opioid rescue dosing by 69% was noted (odds ratio [OR]: 0.31, 95% CI: 0.16–0.80, I2 = 0.0%). Reduction by 61% was also observed in postoperative nausea and vomiting (OR: 0.39, 95% CI: 0.20–0.75, I2 = 60.7%). In the esmolol group, reduction was noted in propofol induction dose (mean difference: −0.53 mg/kg, 95% CI: −0.63–−0.44, I2 = 0.0%). A decrease in end-tidal desflurane equivalent (mean difference: 1.70%, 95% CI: −2.39–−1.02, I2 = 92.0%) and intraoperative opioid usage (fentanyl equivalent, mean difference: 440 μg, 95% CI: −637–−244, 2 = 99.6%) was observed in esmolol group.

It was thus concluded that Esmolol affects the emergence time. As an adjunct, perioperative Esmolol may reduce postoperative pain intensity, opioid consumption, and postoperative nausea vomiting. Given the heterogeneity, larger clinical trials are warranted to confirm these findings.