title: Transcutaneous nicotine does not prevent postoperative nausea and vomiting: a randomized controlled trial.
abstract: OBJECTIVE
  There is empirical evidence that smokers are less likely to suffer from postoperative nausea and vomiting (PONV). We sought to investigate whether transcutaneus nicotine prevents PONV.
  
  
  METHODS
  Non-smokers receiving general anaesthesia for surgery were randomly allocated to Nicotinell Patch 10cm(2) (TTS 10), containing 17.5mg of nicotine (average delivery rate, 7mg 24h(-1) ) or matching placebo patch. Patches were applied 1h before surgery and were left in situ until 24h after surgery (or until the first PONV symptoms occurred).
  
  
  RESULTS
  We randomized 90 patients (45 nicotine, 45 placebo). In the post-anaesthetic care unit, the incidence of nausea was 22.2% with nicotine and 24.4% with placebo (P= 0.80), and the incidence of vomiting was 20.0% with nicotine and 17.8% with placebo (P= 0.78). Cumulative 24h incidence of nausea was 42.2% with nicotine and 40.0% with placebo (P= 0.83), and of vomiting was 31.1% with nicotine and 28.9% with placebo (P= 0.81). PONV episodes tended to occur earlier in the nicotine group. Postoperative headache occurred in 17.8% of patients treated with nicotine and in 15.6% with placebo (P= 0.49). More patients receiving nicotine reported a low quality of sleep during the first postoperative night (26.7% vs. 6.8% with placebo; P= 0.01).
  
  
  CONCLUSIONS
  Non-smokers receiving a prophylactic nicotine patch had a similar incidence of PONV during the first 24h and tended to develop PONV symptoms earlier compared with controls. They had a significantly increased risk of insomnia during the first postoperative night.
authors.affiliation: Division of Anaesthesiology Clinical Trial Unit, University Hospitals of Geneva, Geneva, Switzerland Department of Neurosciences Medical Faculty, University of Geneva, Geneva, Switzerland. christoph.czarnetzki@hcuge.ch
authors.forename: Christoph
authors.initials: C
authors.lastname: Czarnetzki
authors.forename: Eduardo
authors.initials: E
authors.lastname: Schiffer
authors.forename: Christopher
authors.initials: C
authors.lastname: Lysakowski
authors.forename: Guy
authors.initials: G
authors.lastname: Haller
authors.forename: Daniel
authors.initials: D
authors.lastname: Bertrand
authors.forename: Martin R
authors.initials: MR
authors.lastname: Tramèr
mesh_terms: D000279:Administration, Cutaneous; D000328:Adult; D000768:Anesthesia, General / Q000009:adverse effects*; D000932:Antiemetics / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009538:Nicotine / Q000008:administration & dosage*; D020250:Postoperative Nausea and Vomiting / Q000517:prevention & control*; D011184:Postoperative Period; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000932:Antiemetics; D009538:Nicotine