A transdermal nicotine patch is not effective for postoperative pain management in smokers: a pilot dose-ranging study.

Abstract:

BACKGROUND:Nicotine has an antinociceptive effect in animal models. The analgesic effect in humans has been examined, but studies have had mixed results. A proposed etiology is variability in chronic nicotine exposure because of differences in tobacco smoking rates and second-hand smoke exposure. In this study, we examined the postoperative analgesic effect of a transdermal nicotine patch in smokers in a parallel design to a previous study in nonsmokers. METHODS:We conducted a randomized, double-blind, prospective, placebo-controlled trial of 28 patients undergoing abdominal or pelvic surgery who required patient-controlled analgesia and an overnight hospital stay. Before anesthetic induction, a transdermal nicotine patch was applied (0, 5, 10, or 15 mg). The primary outcome variable was postoperative pain reported over the first hour and over the next 5 days using a standard numerical rating scale. Secondary outcome variables were pain medication use, hemodynamic values, nausea, and sedation. RESULTS:Patients treated with nicotine reported higher pain scores than those treated with placebo over the first hour after surgery (P < 0.01, average numerical rating scale increase = 0.67) and there was no difference between groups in the subsequent 5 days (P > 0.05). There was no significant dose effect. Diastolic blood pressure in the first hour was higher in the placebo group compared with the nicotine-treated group (P < 0.01, average increase = 11 mm Hg). There was no difference in nausea or sedation. CONCLUSIONS:Transdermal nicotine, 5-15 mg, failed to relieve postoperative pain or reduce opioid use in smokers.

journal_name

Anesth Analg

journal_title

Anesthesia and analgesia

authors

Olson LC,Hong D,Conell-Price JS,Cheng S,Flood P

doi

10.1213/ANE.0b013e3181bd1612

subject

Has Abstract

pub_date

2009-12-01 00:00:00

pages

1987-91

issue

6

eissn

0003-2999

issn

1526-7598

pii

109/6/1987

journal_volume

109

pub_type

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