Esmolol, Antinociception, and Its Potential Opioid-Sparing Role in Routine Anesthesia Care.

Abstract:

:β-Adrenergic blockade is an important mechanism for reducing morbidity and mortality in patients with hypertension and heart failure. Esmolol has been used widely for its chronotropic and antihypertensive effects. However, there has been recent inquiry regarding perioperative esmolol use and nociceptive modulation. Conventional postoperative analgesic treatment has relied primarily on opioids, which present their own adverse effects and pharmacoepidemiologic repercussions. Esmolol, to date, has not shown any direct analgesic or anesthetic properties; however, recent studies suggest that esmolol may have antinociceptive and postoperative opioid-sparing effects. In this Daring Discourse narrative, we describe the role of esmolol in current perioperative β-blockade guidelines (related to noncardiac surgery), briefly describe studies supporting the antinociceptive effects of esmolol, propose mechanisms for esmolol antinociception, and forecast potential routine esmolol use intraoperatively (as part of a multimodal total intravenous anesthetic) and its effects on opioid sparing. The reading audience of regional anesthesiologists and acute pain medicine physicians is uniquely positioned to take a lead role in promulgating this care advance amid (i) the unwanted effects of the opioid epidemic and (ii) the uncertain notion of whether routine general anesthesia care (with fentanyl) may indirectly be contributing to the epidemic.

journal_name

Reg Anesth Pain Med

authors

Bahr MP,Williams BA

doi

10.1097/AAP.0000000000000873

subject

Has Abstract

pub_date

2018-11-01 00:00:00

pages

815-818

issue

8

eissn

1098-7339

issn

1532-8651

journal_volume

43

pub_type

杂志文章,评审
  • Gastric Ultrasound for the Regional Anesthesiologist and Pain Specialist.

    abstract::This article in our series on point-of-care ultrasound (US) for the regional anesthesiologist and pain management specialist describes the emerging role of gastric ultrasonography. Although gastric US is a relatively new point-of-care US application in the perioperative setting, its relevance for the regional anesthes...

    journal_title:Regional anesthesia and pain medicine

    pub_type: 杂志文章,评审

    doi:10.1097/AAP.0000000000000846

    authors: Haskins SC,Kruisselbrink R,Boublik J,Wu CL,Perlas A

    更新日期:2018-10-01 00:00:00

  • Regional to the Rescue! Axillary Brachial Plexus Nerve Block Facilitates Removal of Entrapped Transradial Catheter Placed for Cardiac Catheterization.

    abstract:OBJECTIVE:Our objective was to describe the first reported use of an axillary brachial plexus block to treat the entrapment of a transradial artery catheter due to vasospasm. CASE REPORT:A 42-year-old man undergoing transradial arterial cardiac catheterization suffered arterial vasospasm causing the catheter to become...

    journal_title:Regional anesthesia and pain medicine

    pub_type: 杂志文章

    doi:10.1097/AAP.0000000000000595

    authors: Fitzgerald BM,Babbel LA,Bacomo FK,Dhanjal ST

    更新日期:2017-07-01 00:00:00

  • Anesthesia residency training in regional anesthesiology and acute pain medicine: a competency-based model curriculum.

    abstract::The Accreditation Council for Graduate Medical Education has shifted to competency-based medical education. This educational framework requires the description of educational outcomes based on the knowledge, skills and behaviors expected of competent trainees. It also requires an assessment program to provide formativ...

    journal_title:Regional anesthesia and pain medicine

    pub_type: 杂志文章

    doi:10.1136/rapm-2020-101480

    authors: Woodworth G,Maniker RB,Spofford CM,Ivie R,Lunden NI,Machi AT,Elkassabany NM,Gritsenko K,Kukreja P,Vlassakov K,Tedore T,Schroeder K,Missair A,Herrick M,Shepler J,Wilson EH,Horn JL,Barrington M

    更新日期:2020-08-01 00:00:00

  • The middle interscalene block: cadaver study and clinical assessment.

    abstract:BACKGROUND AND OBJECTIVES:A variety of brachial plexus block techniques via the interscalene approach have been proposed. We describe here a new middle interscalene perivascular approach to the brachial plexus. To verify its effectiveness, we studied 719 patients scheduled for shoulder arthroscopy. Furthermore, to veri...

    journal_title:Regional anesthesia and pain medicine

    pub_type: 临床试验,杂志文章

    doi:10.1016/j.rapm.2006.05.015

    authors: Alemanno F,Capozzoli G,Egarter-Vigl E,Gottin L,Alberto B

    更新日期:2006-11-01 00:00:00

  • Ultrasound-Guided Percutaneous Peripheral Nerve Stimulation: Neuromodulation of the Sciatic Nerve for Postoperative Analgesia Following Ambulatory Foot Surgery, a Proof-of-Concept Study.

    abstract:BACKGROUND AND OBJECTIVES:Percutaneous peripheral nerve stimulation (PNS) is an analgesic modality involving the insertion of a lead through an introducing needle followed by the delivery of electric current. This modality has been reported to treat chronic pain as well as postoperative pain the day following knee surg...

    journal_title:Regional anesthesia and pain medicine

    pub_type: 杂志文章,随机对照试验

    doi:10.1097/AAP.0000000000000819

    authors: Ilfeld BM,Gabriel RA,Said ET,Monahan AM,Sztain JF,Abramson WB,Khatibi B,Finneran JJ 4th,Jaeger PT,Schwartz AK,Ahmed SS

    更新日期:2018-08-01 00:00:00

  • Influence of lumbar spine pathology on the incidence of paresthesia during spinal anesthesia.

    abstract:BACKGROUND AND OBJECTIVES:Paresthesia occasionally occurs during dural puncture or injection of local anesthetic for spinal anesthesia. Although the incidence of neurologic complications after spinal anesthesia is extremely low, the significance of paresthesia is unknown. The influence of known lumbar spine pathology o...

    journal_title:Regional anesthesia and pain medicine

    pub_type: 杂志文章

    doi:10.1016/s1098-7339(98)90081-5

    authors: Tetzlaff JE,Dilger JA,Wu C,Smith MP,Bell G

    更新日期:1998-11-01 00:00:00

  • Infraclavicular plexus block: multiple injection versus single injection.

    abstract:BACKGROUND AND OBJECTIVES:This prospective, randomized, and multicentered study was undertaken to evaluate the success rate of coracoid infraclavicular nerve block performed with a nerve stimulator when either 1 or 3 motor responses were sought. METHODS:Eighty patients who presented for elbow, forearm, or wrist surger...

    journal_title:Regional anesthesia and pain medicine

    pub_type: 临床试验,杂志文章,多中心研究,随机对照试验

    doi:10.1053/rapm.2002.36456

    authors: Gaertner E,Estebe JP,Zamfir A,Cuby C,Macaire P

    更新日期:2002-11-01 00:00:00

  • Complications associated with eye blocks and peripheral nerve blocks: an american society of anesthesiologists closed claims analysis.

    abstract:BACKGROUND AND OBJECTIVES:Concern for block-related injury and liability has dissuaded many anesthesiologists from using regional anesthesia for eye and extremity surgery, despite many studies demonstrating the benefits of regional over general anesthesia. To determine injury patterns and liability associated with eye ...

    journal_title:Regional anesthesia and pain medicine

    pub_type: 杂志文章,多中心研究

    doi:10.1016/j.rapm.2008.01.016

    authors: Lee LA,Posner KL,Cheney FW,Caplan RA,Domino KB

    更新日期:2008-09-01 00:00:00

  • Regional anesthesia in a very low-birth-weight neonate for a neurosurgical procedure.

    abstract:BACKGROUND AND OBJECTIVES:Peripheral nerve blocks can be successfully utilized in infants for neurosurgical procedures. Our objective was utilizing a series of peripheral nerve blocks for a neurosurgical procedure in a very low-birth-weight neonate. CASE REPORT:We report the use of supraorbital, great auricular, and g...

    journal_title:Regional anesthesia and pain medicine

    pub_type: 杂志文章

    doi:10.1016/j.rapm.2003.09.008

    authors: Suresh S,Bellig G

    更新日期:2004-01-01 00:00:00

  • Effect of acute versus continuous glycemic control on duration of local anesthetic sciatic nerve block in diabetic rats.

    abstract:BACKGROUND AND OBJECTIVES:The duration of nerve block is longer in streptozotocin (STZ)-induced diabetic rats for all local anesthetics (with and without adjuvants) compared with normal rats. Perioperative glycemic control is currently practiced to reduce adverse events in many at-risk patients, especially in diabetic ...

    journal_title:Regional anesthesia and pain medicine

    pub_type: 杂志文章

    doi:10.1097/AAP.0b013e31826742fd

    authors: Kroin JS,Buvanendran A,Tuman KJ,Kerns JM

    更新日期:2012-11-01 00:00:00

  • A case report of reappearance of spinal anesthesia.

    abstract:OBJECTIVE:We present a case of reappearance of spinal anesthesia despite the use of plain (isobaric) lidocaine and without an associated cough or Valsalva maneuver. CASE REPORT:A 66-year-old man had spinal anesthesia for knee arthroscopy. Two hours after the induction of spinal anesthesia and after the patient's motor...

    journal_title:Regional anesthesia and pain medicine

    pub_type: 杂志文章

    doi:10.1016/j.rapm.2007.11.007

    authors: Deleon AM,Benzon HT,Eisenman TS,Doty RA Jr,Newell B,McLaughlin K

    更新日期:2008-05-01 00:00:00

  • The minimum effective concentration of opioids: a revisitation with patient controlled analgesia fentanyl.

    abstract:BACKGROUND AND OBJECTIVES:Whether patients titrate themselves to an individualized blood or plasma opioid concentration (the so-called minimum effective concentration or [MEC]) has been debated extensively. Nevertheless, there is consistent opinion that during patient controlled analgesia (PCA) patients balance accepta...

    journal_title:Regional anesthesia and pain medicine

    pub_type: 临床试验,杂志文章

    doi:10.1016/s1098-7339(00)90008-7

    authors: Woodhouse A,Mather LE

    更新日期:2000-05-01 00:00:00

  • Lumbar plexus and psoas major muscle: not always as expected.

    abstract:BACKGROUND AND OBJECTIVES:Conflicting definitions concerning the exact location of the lumbar plexus have been proposed. The present study was carried out to detect anatomical variants regarding the topographical relation between the lumbar plexus and the psoas major muscle as well as lumbar plexus anatomy at the L4-L5...

    journal_title:Regional anesthesia and pain medicine

    pub_type: 杂志文章

    doi:10.1016/j.rapm.2007.07.016

    authors: Kirchmair L,Lirk P,Colvin J,Mitterschiffthaler G,Moriggl B

    更新日期:2008-03-01 00:00:00

  • Respiratory, neuromuscular, and cardiovascular effects of neosaxitoxin in isoflurane-anesthetized sheep.

    abstract:BACKGROUND:Neosaxitoxin (NeoSTX) is a potent site-1 sodium-channel blocker being developed as a local anesthetic. Doses of 100 μg have been used by local infiltration in anesthetized adult humans without adverse effect. We hypothesized that similar doses could cause significant respiratory, neuromuscular, and cardiovas...

    journal_title:Regional anesthesia and pain medicine

    pub_type: 杂志文章

    doi:10.1097/AAP.0b013e3182424566

    authors: Wylie MC,Johnson VM,Carpino E,Mullen K,Hauser K,Nedder A,Kheir JN,Rodriguez-Navarro AJ,Zurakowski D,Berde CB

    更新日期:2012-03-01 00:00:00

  • Analgesia and anesthesia using the pericapsular nerve group block in hip surgery and hip fracture: a scoping review.

    abstract:INTRODUCTION:Pericapsular nerve group (PENG) block is a novel regional analgesia technique to reduce pain after hip surgery and hip fractures. This review was conducted to summarize current literature. METHODS:A scoping review was carried out using the Joanna Briggs Institute framework. All articles describing the use...

    journal_title:Regional anesthesia and pain medicine

    pub_type: 杂志文章,评审

    doi:10.1136/rapm-2020-101826

    authors: Morrison C,Brown B,Lin DY,Jaarsma R,Kroon H

    更新日期:2021-02-01 00:00:00

  • A Cadaveric Study of Ultrasound-Guided Maxillary Nerve Block Via the Pterygopalatine Fossa: A Novel Technique Using the Lateral Pterygoid Plate Approach.

    abstract:BACKGROUND AND OBJECTIVES:This study aimed to describe and assess the accuracy and feasibility of a novel technique for ultrasound-guided maxillary nerve block using the lateral pterygoid plate (LPP) approach via the pterygopalatine fossa (PPF) in a soft cadaveric model. METHODS:Ten soft cadavers were studied. The cur...

    journal_title:Regional anesthesia and pain medicine

    pub_type: 临床试验,杂志文章

    doi:10.1097/AAP.0000000000000790

    authors: Kampitak W,Tansatit T,Shibata Y

    更新日期:2018-08-01 00:00:00

  • An animal model of "syringe feel" during peripheral nerve block.

    abstract:BACKGROUND:The perception of high resistance during injection of a local anesthetic during regional anesthesia may indicate intraneural injection. Anesthetists' ability to detect high resistance by "syringe feel" has been questioned in the past. The aim of our study was to investigate the anesthetist's ability to detec...

    journal_title:Regional anesthesia and pain medicine

    pub_type: 杂志文章

    doi:10.1097/aap.0b013e3181ac7f38

    authors: Theron PS,Mackay Z,Gonzalez JG,Donaldson N,Blanco R

    更新日期:2009-07-01 00:00:00

  • Risk Factors for and Prediction of a Difficult Neuraxial Block: A Cohort Study of 73,579 Patients from the Danish Anaesthesia Database.

    abstract:BACKGROUND:A difficult neuraxial block (DNB) may be associated with complications. The aims of this study were to estimate the prevalence of DNB, assess patient-related and organizational factors associated with DNB, and evaluate the diagnostic accuracy of an accumulated risk score for predicting DNB. METHODS:A consec...

    journal_title:Regional anesthesia and pain medicine

    pub_type: 杂志文章

    doi:10.1097/AAP.0000000000000293

    authors: Stendell L,Lundstrøm LH,Wetterslev J,Itenov TS,Rosenstock CV

    更新日期:2015-09-01 00:00:00

  • The effect of intrathecal epinephrine on epidural infused analgesics during labor.

    abstract:BACKGROUND AND OBJECTIVES:In order to prolong labor analgesia, one may add intrathecal epinephrine to the combination of bupivacaine and fentanyl. In this study, we tested the hypothesis that the addition of intrathecal epinephrine would lessen the requirement for a rescue dose of epidural analgesia during labor. METH...

    journal_title:Regional anesthesia and pain medicine

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1053/rapm.2003.50026

    authors: Okutomi T,Mochizuki J,Amano K,Datta S

    更新日期:2003-03-01 00:00:00

  • The efficacy of continuous intrabursal infusion with morphine and bupivacaine for postoperative analgesia after subacromial arthroscopy.

    abstract:BACKGROUND AND OBJECTIVES:The aim of this study was to determine whether an intrabursal morphine and bupivacaine mixed infusion provides useful analgesia for prolonged pain relief after subacromial arthroscopic operation. METHODS:A continuous intrabursal infusion catheter was inserted at the conclusion of the subacrom...

    journal_title:Regional anesthesia and pain medicine

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1053/rapm.2002.31209

    authors: Park JY,Lee GW,Kim Y,Yoo MJ

    更新日期:2002-03-01 00:00:00

  • Association of perioperative use of nonsteroidal anti-inflammatory drugs with postoperative myocardial infarction after total joint replacement.

    abstract:BACKGROUND AND OBJECTIVES:Use of nonsteroidal anti-inflammatory drug (NSAIDs) analgesics is controversial because of cardiovascular risk, but perioperative use may be advantageous for total joint replacement. Thus, we performed this single-center observational cohort study to determine any association between NSAID use...

    journal_title:Regional anesthesia and pain medicine

    pub_type: 杂志文章

    doi:10.1097/AAP.0b013e31823354f5

    authors: Liu SS,Bae JJ,Bieltz M,Ma Y,Memtsoudis S

    更新日期:2012-01-01 00:00:00

  • Spinal cord compression from intrathecal catheter-tip inflammatory mass: case report and a review of etiology.

    abstract:OBJECTIVES:The majority of intrathecal pumps are implanted by anesthesiologists. Despite a recent increase in case reports involving intrathecal catheter-tip inflammatory masses, this complication is rarely reported in the anesthesiology literature. The present case report describes a patient with spinal cord compressi...

    journal_title:Regional anesthesia and pain medicine

    pub_type: 杂志文章,评审

    doi:10.1016/j.rapm.2004.01.012

    authors: Peng P,Massicotte EM

    更新日期:2004-05-01 00:00:00

  • Spread of Quadratus Lumborum Block to the Paravertebral Space Via Intramuscular Injection: A Volunteer Study.

    abstract:BACKGROUND AND OBJECTIVES:Several types of quadratus lumborum block (QLB) are used for postoperative analgesia and are believed to be effective against both somatic and visceral pain via a local anesthetic (LA) effect in the paravertebral space (PVS). However, it remains unclear whether all QLB techniques result in LA ...

    journal_title:Regional anesthesia and pain medicine

    pub_type: 杂志文章

    doi:10.1097/AAP.0000000000000735

    authors: Tamura T,Kitamura K,Yokota S,Ito S,Shibata Y,Nishiwaki K

    更新日期:2018-05-01 00:00:00

  • A Randomized Comparison Between Single- and Triple-Injection Subparaneural Popliteal Sciatic Nerve Block.

    abstract:BACKGROUND AND OBJECTIVES:This prospective randomized trial compared ultrasound-guided single-injection (SI) and triple-injection (TI) subparaneural popliteal sciatic nerve block. We hypothesized that multiple injections are not required when local anesthetic (LA) is deposited under the paraneurium because the latter e...

    journal_title:Regional anesthesia and pain medicine

    pub_type: 杂志文章,多中心研究,随机对照试验

    doi:10.1097/AAP.0000000000000253

    authors: Tiyaprasertkul W,Bernucci F,González AP,Leurcharusmee P,Yazer MS,Techasuk W,Arnuntasupakul V,de la Garza DC,Finlayson RJ,Tran DQ

    更新日期:2015-07-01 00:00:00

  • Labor Epidural Intolerance Due to a Congenitally Narrowed Spinal Canal.

    abstract::Reports exist of severe upper back pain of unknown etiology after administration of large volumes into the epidural space. We present a case of an otherwise healthy parturient who developed severe upper back and neck pain after receiving only a small volume of epidural medication. Magnetic resonance imaging revealed a...

    journal_title:Regional anesthesia and pain medicine

    pub_type: 杂志文章

    doi:10.1097/AAP.0000000000000493

    authors: Dickerson DM,Dai R,Scavone BM,McDade W

    更新日期:2016-11-01 00:00:00

  • Multimodal Analgesic Protocol and Postanesthesia Respiratory Depression During Phase I Recovery After Total Joint Arthroplasty.

    abstract:BACKGROUND:Multimodal analgesia protocols have shortened hospitalizations after total joint arthroplasty. It is unclear whether individual components of these protocols are associated with respiratory depression during phase I postanesthesia recovery. OBJECTIVES:To test the hypothesis that sedating analgesics used in ...

    journal_title:Regional anesthesia and pain medicine

    pub_type: 杂志文章

    doi:10.1097/AAP.0000000000000257

    authors: Weingarten TN,Jacob AK,Njathi CW,Wilson GA,Sprung J

    更新日期:2015-07-01 00:00:00

  • Cyclooxygenase-2 inhibition potentiates morphine antinociception at the spinal level in a postoperative pain model.

    abstract:BACKGROUND AND OBJECTIVES:After peripheral inflammatory stimuli, spinal cord cyclooyxgenase-2 (COX-2) mRNA and protein levels increase, whereas COX-1 is unchanged. In animal models of inflammatory pain, intrathecal COX-2 selective inhibitors suppress hyperalgesia. However, the role of spinal COX-2 inhibition in postope...

    journal_title:Regional anesthesia and pain medicine

    pub_type: 杂志文章

    doi:10.1053/rapm.2002.35521

    authors: Kroin JS,Buvanendran A,McCarthy RJ,Hemmati H,Tuman KJ

    更新日期:2002-09-01 00:00:00

  • Postoperative pain guidelines.

    abstract:BACKGROUND AND OBJECTIVES:Postoperative pain is the expected but nonetheless undesirable byproduct of all surgical procedures. Humanitarian concerns and recent quasi-governmental regulations have heightened awareness about the importance of treating postoperative pain. This guideline builds upon the foundation created ...

    journal_title:Regional anesthesia and pain medicine

    pub_type: 指南,杂志文章

    doi:10.1016/s1098-7339(03)00035-x

    authors: Rosenquist RW,Rosenberg J,United States Veterans Administration.

    更新日期:2003-07-01 00:00:00

  • Intensity of the stimulating current may not be a reliable indicator of intraneural needle placement.

    abstract:BACKGROUND AND OBJECTIVES:The current intensity at which a motor response is elicited with an intraneural needle placement has been inadequately studied. We hypothesized that electrical current delivered through an intraneurally placed needle does not always result in an evoked motor response. Our secondary objective w...

    journal_title:Regional anesthesia and pain medicine

    pub_type: 杂志文章

    doi:10.1016/j.rapm.2007.12.010

    authors: Tsai TP,Vuckovic I,Dilberovic F,Obhodzas M,Kapur E,Divanovic KA,Hadzic A

    更新日期:2008-05-01 00:00:00

  • Epidemiology and outcome of postural headache management in spontaneous intracranial hypotension.

    abstract:BACKGROUND AND OBJECTIVES:Spontaneous intracranial hypotension is a postural headache syndrome unrelated to dural puncture. Due to the apparent failure of epidural blood patch to relieve headache in spontaneous intracranial hypotension, we investigated the epidemiologic features and treatment outcomes of this condition...

    journal_title:Regional anesthesia and pain medicine

    pub_type: 杂志文章

    doi:10.1053/rapm.2001.28275

    authors: Diaz JH

    更新日期:2001-11-01 00:00:00