Abstract

Perioperative pain management is fundamental to providing patient comfort while promoting optimal recovery. With increasing awareness of the adverse effects, prolonged hospital stays, and increased mortality surrounding opioid administration, opioid-sparing techniques have gained interest.

A 36-year-old female weighing 102 kg presented for an elective right partial thyroidectomy due to a history of benign thyroid nodules. Additional medical history included obesity, obstructive sleep apnea, and gastroesophageal reflux disease. General anesthesia with a nerve integrity monitoring endotracheal tube was performed. A multimodal analgesic approach was implemented. The patient received fentanyl 175 mcg, acetaminophen 1 g, dexamethasone 10 mg, dexmedetomidine 20 mcg intravenously, and local anesthetic infiltration at the surgical site. Despite multiple adjuncts utilized for pain control, the patient displayed persistent signs of pain. She became hypertensive and tachycardic during induction, which persisted intraoperatively, requiring escalating doses of analgesics to maintain hemodynamic stability. With increased pain requirements, multimodal analgesic strategies implemented, and unstable hemodynamics throughout the case, the following clinical question was prompted: in adult surgical patients who are undergoing general anesthesia, how does esmolol administration in addition to opioids compare to those who receive opioids without esmolol impact perioperative pain management?

Esmolol, a cardio-selective beta blocker, has demonstrated potential analgesic properties. Proposed mechanisms include suppression of the surgical stress response via beta-adrenergic blockade in the brainstem and spinal cord, resulting in reduced norepinephrine and inflammatory mediators, as well as prolonged opioid effects due to decreased cardiac output and metabolism. Studies suggest administering a bolus prior to induction followed by a continuous infusion intraoperatively to decrease perioperative opioid consumption, improve hemodynamic stability, and reduce anesthetic requirements.

Anesthesia providers implementing multimodal analgesia can utilize esmolol as an adjunct for perioperative pain management. Recommended dosing includes a 0.5–1 mg/kg IV bolus prior to induction followed by a continuous infusion of 5–50 mcg/kg/min.

Author Details

Lauren M. Bivin, DNP(c), BSN, RN and Terri M. Cahoon, DNP, CRNA

Sigma Membership

Non-member

Type

DNP Capstone Project

Format Type

Text-based Document

Study Design/Type

Case Study/Series

Research Approach

Translational Research/Evidence-based Practice

Keywords:

Esmolol, Opioid-Sparing Techniques, Multimodal Analgesia

Advisor

Allyson Maddox

Degree

DNP

Degree Grantor

Samford University

Degree Year

2026

Rights Holder

All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record. All permission requests should be directed accordingly and not to the Sigma Repository. All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.

Review Type

None: Degree-based Submission

Acquisition

Proxy-submission

Date of Issue

2026-02-04

Full Text of Presentation

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Additional Files

Abstract.pdf (369 kB)

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