title: Intranasal nicotine increases postoperative nausea and is ineffective in reducing pain following laparoscopic bariatric surgery in tobacco-Naïve females: a randomized, double blind trial.
abstract: BACKGROUND
  Nicotine is a known analgesic. Our primary aim was to test the hypothesis that intranasal nicotine administered intraoperatively reduces the need for postoperative opioids. The secondary outcomes included evaluation of both postoperative pain and nausea and vomiting (PONV).
  
  
  METHODS
  Nonsmoking female patients undergoing laparoscopic bariatric operations were randomized to receive either 3 mg intranasal nicotine (N = 42) or placebo spray (N = 47) at the conclusion of surgery. Postoperative opioid use converted to intravenous morphine equivalents (iv MEQ) and PONV rates were recorded during both the recovery room postanesthesia care unit (PACU) stay and the first 24 postoperative hours. All patients received multimodal antiemetic prophylaxis.
  
  
  RESULTS
  Total iv MEQ were not significantly reduced during the PACU stay in patients receiving nicotine (median [interquartile range (IQR)], 5.3 [0, 10.0] mg for nicotine vs. 5.2 [0, 12.7] mg for placebo, one-tailed P = 0.414) or for the first 24 h following PACU discharge (39.6 [20.0, 52.5] mg for nicotine vs. 32.7 [20.3, 51.3] mg for placebo, one-tailed P = 0.752). For the combined period (PACU + 24-h post-PACU discharge), iv MEQ were 45.8 [27.0, 58.6] mg for nicotine and 39.4 [23.5, 60.0] mg for placebo, one-tailed P = 0.801. Compared to placebo, a higher percentage of patients administered nicotine received antiemetics in the PACU (57.1 vs. 25.5 %, P = 0.002).
  
  
  CONCLUSIONS
  Intraoperative intranasal nicotine did not exhibit opioid-sparing effect in nonsmoking bariatric female patients. Despite antiemetic prophylaxis, the use of nicotine was associated with the higher frequency of the use of rescue antiemetics in PACU.
authors.affiliation: Mayo Clinic Department of Anesthesiology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN, 55905, USA, weingarten.toby@mayo.edu.
authors.forename: Toby N
authors.initials: TN
authors.lastname: Weingarten
authors.forename: Brian P
authors.initials: BP
authors.lastname: McGlinch
authors.forename: Lavonne
authors.initials: L
authors.lastname: Liedl
authors.forename: Michael L
authors.initials: ML
authors.lastname: Kendrick
authors.forename: Todd A
authors.initials: TA
authors.lastname: Kellogg
authors.forename: Darrell R
authors.initials: DR
authors.lastname: Schroeder
authors.forename: Juraj
authors.initials: J
authors.lastname: Sprung
mesh_terms: D000281:Administration, Intranasal; D000328:Adult; D000700:Analgesics / Q000008:administration & dosage*; D000932:Antiemetics / Q000008:administration & dosage*; D050110:Bariatric Surgery / Q000009:adverse effects* / Q000379:methods; D018890:Chemoprevention; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods; D008875:Middle Aged; D009538:Nicotine / Q000008:administration & dosage*; D009767:Obesity, Morbid / Q000188:drug therapy / Q000453:epidemiology / Q000601:surgery*; D010149:Postoperative Pain / Q000188:drug therapy* / Q000453:epidemiology; D020250:Postoperative Nausea and Vomiting / Q000188:drug therapy* / Q000453:epidemiology; D064424:Tobacco Use; D017211:Treatment Failure
chemical_list: D000700:Analgesics; D000932:Antiemetics; D009538:Nicotine