A transdermal nicotine patch is not effective for postoperative pain management in smokers: a pilot dose-ranging study.
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.
Olson
Luke C
LC
Department of Anesthesiology, Columbia University Medical Center, New York, New York, USA.
Hong
Daewha
D
Conell-Price
Jessamyn S
JS
Cheng
Sean
S
Flood
Pamela
P
D000279:Administration, Cutaneous; D000328:Adult; D016058:Analgesia, Patient-Controlled; D000700:Analgesics / Q000008:administration & dosage* / Q000009:adverse effects; D000701:Analgesics, Opioid / Q000008:administration & dosage; D004304:Dosage Forms; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage; D009538:Nicotine / Q000008:administration & dosage* / Q000009:adverse effects; D018722:Nicotinic Agonists / Q000008:administration & dosage* / Q000009:adverse effects; D010147:Pain Measurement; D010149:Postoperative Pain / Q000209:etiology / Q000517:prevention & control*; D010865:Pilot Projects; D011446:Prospective Studies; D012907:Smoking / Q000009:adverse effects*; D013997:Time Factors; D017211:Treatment Failure
D000700:Analgesics; D000701:Analgesics, Opioid; D004304:Dosage Forms; D018722:Nicotinic Agonists; D009538:Nicotine; D009020:Morphine