title: Randomised trial of intranasal nicotine and postoperative pain, nausea and vomiting in non-smoking women.
abstract: BACKGROUND
  The primary aim of this study is to test the hypothesis that intranasal nicotine reduces postoperative opioid use among non-smoking women. The second aim is to determine the effects of intranasal nicotine on the incidence of postoperative nausea and vomiting (PONV).
  
  
  METHODS
  In this double-blind, randomised placebo-controlled trial, non-smoking women undergoing gynaecological procedures received either 3 mg intranasal nicotine (N=90) or placebo spray (N=89) at the conclusion of surgery. Postoperative opioid use (intravenous morphine equivalents) and PONV rates were recorded during the recovery room (postanaesthesia care unit, PACU) stay and first 24 postoperative hours.
  
  
  RESULTS
  From an overall analysis, opioid dose administered within the first 24 h was lower in patients receiving nicotine [median (25th, 75th) 38 (17, 62) mg for placebo vs. 25 (13, 46) mg for nicotine; P=0.012]. Inpatients who received intranasal nicotine used less opioid. From an overall analysis, patients in the nicotine group were more likely to experience nausea (71.1 vs. 56.2% P=0.044), receive rescue antiemetics (57.8 vs. 38.2% P=0.011), and report higher Nausea Verbal Descriptive Scores [2 (0, 2; vs. 1 (0, 2), P=0.006] in PACU. Inpatients who received nicotine were more likely to receive antiemetics (P=0.009) and report higher Nausea Verbal Descriptive Scores (P=0.025) in the PACU.
  
  
  CONCLUSIONS
  Intraoperative use of intranasal nicotine has a sustained opioid-sparing effect in non-smoking women undergoing gynaecological procedures and is associated with a higher frequency of PONV.
authors.affiliation: Department of Anesthesiology, College of Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Jankowski
authors.forename: Toby N
authors.initials: TN
authors.lastname: Weingarten
authors.forename: David P
authors.initials: DP
authors.lastname: Martin
authors.forename: Francis X
authors.initials: FX
authors.lastname: Whalen
authors.forename: John B
authors.initials: JB
authors.lastname: Gebhart
authors.forename: Lavonne M
authors.initials: LM
authors.lastname: Liedl
authors.forename: David R
authors.initials: DR
authors.lastname: Danielson
authors.forename: Ashley M
authors.initials: AM
authors.lastname: Nadeau
authors.forename: Darrell R
authors.initials: DR
authors.lastname: Schroeder
authors.forename: David O
authors.initials: DO
authors.lastname: Warner
authors.forename: Juraj
authors.initials: J
authors.lastname: Sprung
mesh_terms: D000281:Administration, Intranasal; D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D000932:Antiemetics / Q000008:administration & dosage / Q000627:therapeutic use; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D013509:Gynecologic Surgical Procedures / Q000379:methods; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D009538:Nicotine / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology*; D018722:Nicotinic Agonists / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology*; D010149:Postoperative Pain / Q000517:prevention & control*; D020250:Postoperative Nausea and Vomiting / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology
chemical_list: D000701:Analgesics, Opioid; D000932:Antiemetics; D018722:Nicotinic Agonists; D009538:Nicotine