Intra-operative esmolol and pain following mastectomy: A randomised clinical trial.
Eur J Anaesthesiol
; 38(7): 735-743, 2021 07 01.
Article
em En
| MEDLINE
| ID: mdl-33831899
ABSTRACT
BACKGROUND:
Esmolol is a beta-1 selective blocker that has been shown to reduce postoperative pain. Its antinociceptive effects have not been tested following mastectomy.OBJECTIVE:
To evaluate the safety, efficacy and antinociception of intra-operative esmolol infusion after mastectomy.DESIGN:
Randomised, double-blinded, placebo-controlled trial.SETTING:
Tertiary referral centre, Brasília, Brazil. Recruitment July 2015 to July 2017. PATIENTS Seventy women scheduled for mastectomy, ASA I to III, aged 18 to 75âyears. Four were excluded.INTERVENTIONS:
All underwent general anaesthesia. The intervention group received a bolus of 0.5âmgâkg-1 of esmolol over 10âmin followed by a continuous infusion of 100âµgâkg-1âmin-1. The placebo group received saline. MAIN OUTCOMEMEASURES:
The primary outcome was pain at rest 24âh after mastectomy as measured by a 0 to 10 numeric rating scale.RESULTS:
Pain scores at rest 24âh after mastectomy were lower in esmolol-treated patients compared with placebo (mean differenceâ=â-1.51, 95% confidence interval (CI), -2.36 to -0.65, Pâ=â0.001). On arrival in the postanaesthesia care unit (PACU), the occurrence of pain was also lower in the esmolol group, at rest and on effort (Pâ=â0.009 and Pâ=â0.013, respectively), on discharge from PACU (Pâ=â0.009 and Pâ=â0.015), 12âh (Pâ=â0.01 and Pâ=â0.007) and on effort in the 24 postoperative hours (Pâ=â0.003). Mean morphine consumption was reduced by 77% in the esmolol group compared with the placebo group (mean differenceââ=â-2.52âmg, 95% CIâ=â-3.67 to -1.38, Pâ<â0.001). The length of hospital stay was shorter for the esmolol group (mean differenceâ=â-6.9âh, 95% CI, -13.4 to -0.31, Pâ=â0.040).CONCLUSION:
Esmolol was well tolerated, allowed a notable reduction in the dose of rescue analgesics and demonstrated superior efficacy compared to placebo for pain management after mastectomy. TRIAL REGISTRATION ClinicalTrials/NCT02466542.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Neoplasias da Mama
Tipo de estudo:
Clinical_trials
/
Diagnostic_studies
/
Etiology_studies
Limite:
Female
/
Humans
País/Região como assunto:
America do sul
/
Brasil
Idioma:
En
Ano de publicação:
2021
Tipo de documento:
Article