ArticleCurrent medical science2026
Perioperative Esmolol Is Associated with Early Opioid Sparing in Patients with Ischemic Heart Disease: Evidence from a Retrospective Cohort and an Incisional Pain Rat Model.
Article in Current medical science, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivePrevious studies have confirmed the opioid-sparing and analgesic properties of perioperative esmolol, yet relevant clinical evidence specifically focusing on patients with ischemic heart disease (IHD) remains scarce, and the spinal nociceptive mechanism underlying esmolol-induced pain relief has not been fully elucidated. This study aimed to investigate the association between perioperative esmolol administration and early postoperative opioid demand in IHD patients undergoing elective non-cardiac surgery, and further explore the role of spinal 5-hydroxytryptamine (5-HT)/5-HT
methodsFor the clinical retrospective cohort, eligible IHD patients were divided into esmolol-exposed and non-exposed groups balanced via 1:1 propensity score matching. The primary outcome was cumulative 24-h postoperative opioid consumption converted to intravenous morphine equivalents (IME); secondary endpoints included early Numeric Rating Scale (NRS) pain scores, opioid-related adverse events and perioperative cardiovascular safety indicators. In animal experiments, intrathecal esmolol or selective 5-HT
resultsAfter matching, 52 patients were included in each group. Perioperative esmolol was associated with a 3.0 mg reduction in 24 h IME (mean difference [MD] = -3.0, 95% CI [-4.9, -1.1], P = 0.002), alongside lower post-anesthesia care unit (PACU) opioid consumption (MD = -2.3, 95% CI [-4.2, - 0.3], P = 0.022) and decreased resting NRS scores in PACU (MD = -0.8, 95% CI [-1.3, -0.2], P = 0.006) and at postoperative 6 h (MD = -0.6, 95% CI [-1.1, -0.02], P = 0.043); no intergroup difference in NRS was observed at 24 h (P = 0.379). All opioid-related adverse events showed comparable incidence between groups (all P > 0.05). Intraoperative heart rate was significantly lower in the esmolol group (MD = -4.4 beats/min, 95% CI [-7.8, -1.0], P = 0.012), while intraoperative mean arterial pressure (MAP) and major cardiovascular complications exhibited no between-group differences (all P > 0.05). In rats, the results revealed transiently elevated paw withdrawal mechanical thresholds after intrathecal esmolol (P < 0.05 at 5 and 10 min), accompanied by suppressed surgery-induced upregulation of spinal 5-HT and 5-HT
conclusionsPerioperative esmolol is associated with early opioid-sparing and mild relief of acute postoperative pain in IHD patients receiving elective non-cardiac surgery, without increasing cardiovascular risks, whereas this regimen fails to reduce opioid-associated side effects. Preclinical data suggest that spinal 5-HT/5-HT
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