Labetalol as an Alternative to Esmolol and Fentanyl for Maintaining Hemodynamic Stability during Laparoscopic Surgery: Comparative Effects on Recovery Profiles and a Literature Review

β-blockers like labetalol and esmolol have been successfully used for controlling acute autonomic responses during surgery. Objective: To compare the intraoperative use of labetalol and esmolol to fentanyl for maintaining hemodynamic stability during laparoscopic surgery and assess their effects on recovery profiles. Methods: 75 patients were randomly assigned to receive one of three different adjunctive treatments regimens. Immediately prior to induction of anesthesia, 1 mL of the unlabeled study medication (fentanyl [50μg/mL], or labetalol [5mg/mL], or esmolol [10 mg/mL]) was administered. A second 1mL dose of the same study medication was administered immediately before skin incision and subsequently as needed [‘rescue’] during the surgical procedure to maintain heart rate (HR) and mean arterial pressure within 15% of the pre-induction baseline values. Results: The labetalol and esmolol groups had similar intraoperative HR and MAP values compared to the fentanyl group (p=0.4 and p=0.1 respectively). Fewer patients in the labetalol group required intraoperative rescue medications compared to the esmolol and fentanyl groups (p=0.0003). There were no significant differences in the requirement for parenteral opioid medication in the early postoperative period among the three groups. Of the post-discharge recovery outcomes studied, only incidence of ‘low appetite’ differed among the three groups, favoring the labetalol group over the fentanyl group (p=0.05). Labetalol was also less costly than both esmolol and fentanyl. Conclusion: Labetalol and esmolol were found to be comparable to fentanyl for maintaining hemodynamic stability during laparoscopic surgery. However, labetalol required less intraoperative rescue medication and had less adverse effect on appetite in the post-discharge period.