BETA-BLOCKERS IN ERAS: MODULATING THE ADRENERGIC SURGE AND METABOLIC STRESS FOR OPTIMIZED RECOVERY
Main Article Content
Keywords
Beta-blockers, ERAS, surgical stress, adrenergic response, postoperative recovery, pain control, hemodynamic stability
Abstract
Background: Enhanced Recovery After Surgery (ERAS) protocols seek to optimize recovery and minimize postoperative complications by alleviating surgical strain and facilitating swift recuperation. The adrenergic physiologic response to surgical trauma continues to be an issue even with standardized perioperative care. Within these ERAS constructs, beta-blockers appear to be useful for blunting this stress response and provide additional advantages. To evaluate the effectiveness of perioperative beta-blockers in controlling the adrenergic and metabolic stress response in patients undergoing major elective surgeries under ERAS protocols, and to assess their impact on recovery outcomes.
Methods: A randomized controlled trial was performed at Ayub Medical College from January 2022 to January 2023 with a sample size of 89 adult subjects who were scheduled to undergo major elective surgical procedures. Patients were divided into two groups: one received beta-blockers coupled with Enhanced Recovery after Surgery (ERAS) protocols while the other received ERAS only. The hemodynamic metrics, metabolic parameters, pain scores, opioid usage, duration of hospital stay, and complication rates were all documented and analyzed using relevant statistical methodologies.
Results: The beta-blocker group demonstrated significantly lower intraoperative heart rate and blood pressure. Postoperatively, this group had reduced pain scores, lower opioid requirements, fewer complications, and shorter hospital stays compared to the standard ERAS group (p < 0.05 for all). No significant differences were observed in ICU admissions or 30-day readmissions.
Conclusion: The addition of beta-blockers to ERAS protocols appears to be a safe and effective strategy to modulate physiological stress responses and promote faster recovery. Their role in surgical care should be further explored in broader patient populations.
References
2. Bruning, R., et al., Beta-adrenergic blockade in critical illness. Frontiers in Pharmacology, 2021. 12: p. 735841.
3. Ahl, R., et al., Effects of beta-blocker therapy on mortality after elective colon cancer surgery: a Swedish nationwide cohort study. BMJ open, 2020. 10(7): p. e036164.
4. Packer, M., What causes sudden death in patients with chronic heart failure and a reduced ejection fraction? European Heart Journal, 2020. 41(18): p. 1757-1763.
5. Niranjan, P.K. and S. Bahadur, Recent developments in drug targets and combination therapy for the clinical management of hypertension. Cardiovascular & Haematological Disorders-Drug Targetsrug Targets-Cardiovascular & Hematological Disorders), 2023. 23(4): p. 226-245.
6. Valtola, A., Clinical insights into the pharmacokinetic aspects of fentanyl, metoprolol and oxycodone dosing after cardiac surgery. 2021, Itä-Suomen yliopisto.
7. Wang, H., et al., Effect of low-dose dexmedetomidine on hemodynamics and postoperative outcome in patients undergoing anesthesia during offpump coronary bypass surgery. Int J Clin Exp Med, 2020. 13(9): p. 6268-6276.
8. Bracchitta, L., et al., Sarcopenia in Other Settings: Primary Care, Cardiovascular Disease, Surgery. Sarcopenia: Research and Clinical Implications, 2021: p. 111-131.
9. Drakopoulou, M., et al., Adult Congenital Heart Disease. Pediatric Cardiac Surgery, 2023: p. 999-1054.
10. Hussain, S.F. and G. Hina, A comparative study of two different doses of dexmedetomidine for attenuating the haemodynamic response to tracheal intubation. Journal of Contemporary Clinical Practice, 2023. 9: p. 45-51.
11. Lebl, D.R. and M.K. Urban, Perioperative Care of the Complex Spine and Scoliosis Surgery Patient. Perioperative Care of the Orthopedic Patient, 2020: p. 379-392.
12. Jangra, K., H. Bhagat, and A. Aggarwal, for Neuroscience in Anesthesiology and Critical Care, September 11-13, 2020. J Neurosurg Anesthesiol, 2020. 32(4).
13. Pal, N. and M.D. Kertai, Perioperative precision medicine: where are we in 2020? Current Opinion in Anesthesiology, 2020. 33(3): p. 463-474.
14. Santos, R.H.L., Terapia nutricional artificial efetiva e complicações no doente cirúrgico. 2020, Universidade de Lisboa (Portugal).
15. Boyce, T.G., et al., The Use of β-Adrenergic Receptor Antagonists in Psychiatry: A Review. Journal of the Academy of Consultation-Liaison Psychiatry, 2021. 62(4): p. 404-412 DOI: https://doi.org/10.1016/j.jaclp.2020.12.009.
16. Chrysant, S.G. and G.S. Chrysant, Antihypertensive and cardioprotective effects of three generations of beta-adrenergic blockers: an historical perspective. Hospital Practice, 2022. 50(3): p. 196-202.
17. Wołowiec, Ł., et al., Beta-blockers in cardiac arrhythmias–Clinical pharmacologist’s point of view. Frontiers in pharmacology, 2023. 13: p. 1043714.
18. Gupta, A., J. Gupta, and A. Gupta, Chemistry of Beta-blockers and their role in the Cardiovascular Disorders. Int. J. Curr. Res. Chem. Pharm. Sci, 2023. 10(2): p. 1-6.
19. Khan, Z., et al., Beta-Adrenergic Blockers’ Supportive and Adverse Role in Hypertension: A Review of Three Generations: Beta-adrenergic blockers role in hypertension. Pakistan Journal of Medicine and Dentistry, 2022. 11(1): p. 63-71.
20. Strauss, M.H., A.S. Hall, and K. Narkiewicz, The combination of beta-blockers and ACE inhibitors across the spectrum of cardiovascular diseases. Cardiovascular Drugs and Therapy, 2023. 37(4): p. 757-770.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Dr. Rafat Ullah
Consultant Surgeon, Department of General Surgery, Ayub Medical College/Ayub teaching Hospital, Abbottabad, Pakistan
Dr. Fazli Junaid
Assistant Professor, Department of General Surgery, Ayub Medical College, Abbottabad/ Ayub Teaching Hospital, Abbottabad, Pakistan
Dr. Misbah Ullah
Resident Surgeon, Department of General Surgery, Ayub Medical College/ Ayub Teaching Hospital, Abbottabad, Pakistan
Dr Bilal Ahmad
Consultant Neurosurgeon, Department of Neurosurgery, King Abdullah Teaching Hospital, Mansehra, Pakistan
Dr Bushra Rashid
Assistant Professor, Department of Obstetrics and Gynaecology, Frontier Medical College, Abbottabad, Pakistan
Dr Haider Ali
Consultant Neurosurgeon, Department of Neurosurgery, Ayub Medical Complex, Abbottabad, Pakistan