Background: Anesthesia providers often utilize multimodal therapy for synergistic analgesia while minimizing additional risk. Investigation into the benefits and risks of atypical analgesics and their role in perioperative analgesia remains a topic of discussion. Both esmolol and lidocaine have multiple proposed analgesic mechanisms, however their efficacy in perioperative pain management has yet to be established.
Purpose: The purpose of this systematic review was to compare the individual effects of lidocaine and esmolol on pain scores and opioid consumption in adult surgical patients undergoing laparoscopic cholecystectomy to determine superiority.
Methods: A comprehensive review of the literature provided context on postoperative pain and multimodal analgesia. The results of three randomized controlled trials (RCT’s) directly comparing esmolol to lidocaine were qualitatively evaluated with respect to postoperative pain and opioid consumption. PRISMA guided the systematic review while CASP was used to assess study quality.
Results: The findings suggest that esmolol and lidocaine are likely equivalent in their analgesic potency and opioid sparing effects. Esmolol may be slightly superior to lidocaine at higher doses around 50mcg/kg/min, though more high quality RCT’s are required.
Conclusions: More research is needed to determine if the analgesic benefits of esmolol outweigh the potential risks of this medication, particularly those associated with hemodynamic status. However, esmolol and lidocaine may both be considered as adjunctive analgesics by anesthesia providers when building anesthetic management plans in minimally invasive surgeries
