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ANALGESIA

Transdermal Nicotine Patch Failed to Improve Postoperative Pain Management

Alparslan Turan, MD^*, Paul F. White, PhD, MD, Onur Koyuncu, MD, Beyhan Karamanliolu, MD^*, Gaye Kaya, MD^*, and Christian C. Apfel, MD, PhD^||

From the *Department of Anesthesiology, Trakya University, Turkey, and Department of Anesthesiology and Perioperative Medicine, and the Outcomes Research Institute, University of Louisville, Louisville, Kentucky; Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas; and Departments of Anesthesiology, ||Anesthesiology and Perioperative Care, Perioperative Clinical Research Care, University of California at San Francisco, San Francisco, California.

Address correspondence and reprint requests to Dr. Alparslan Turan, Department of Anesthesiology and Perioperative Medicine, 530 S. Jackson St., University Hospital, Louisville, KY 40202. Address e-mail to alparslanturan{at}yahoo.com.

Abstract

BACKGROUND: A single 3 mg intranasal dose of nicotine has been reported to have analgesic properties. We designed placebo-controlled study to test the hypothesis that transdermal nicotine (TDN) administered over a 3-day period would decrease postoperative pain and opioid analgesic usage and improve the recovery process after lower abdominal surgery.

METHODS: Ninety-seven patients undergoing abdominal hysterectomy procedures were randomly assigned to one of two treatment groups: (1) control group received inert (sham) patches 1 h before and for 2 days after surgery, or the (2) nicotine group received TDN 30 (21 mg nicotine) patches 1 h before induction of anesthesia and for two additional days after surgery. The anesthetic technique was identical in both groups, and the postoperative assessments included verbal rating scales for pain and sedation, IV patient-controlled analgesia morphine usage, quality of recovery assessment, recovery of bowel function, resumption of normal activities, and patient satisfaction with their pain management. Follow-up evaluations were performed at 1 and 3 mo after the operation to assess late recovery events.

RESULTS: Postoperative patient-controlled analgesia morphine usage and pain scores while supine or sitting up, intraoperative fentanyl use, oral analgesic consumption, return of bowel sounds, and passage of flatus did not differ between the two groups. Although ambulation and hospitalization times, as well as quality of recovery scores, did not differ, resumption of oral intake was delayed in the nicotine group. Discharge eligibility scores were higher in the nicotine group at 48 and 72 h compared with the control group, but the time to return to work was 19 days in both treatment groups.

CONCLUSIONS: Perioperative administration of a high-dose TDN patch did not improve postoperative pain control or decrease the analgesic requirement after pelvic gynecological surgery. Despite delayed resumption of oral intake, more patients in the nicotine group were ready for discharge at 48 and 72 h after surgery. However, times to resuming activities of daily living were similar in both groups.

This article has been cited by other articles:

				L. C. Olson, D. Hong, J. S. Conell-Price, S. Cheng, and P. Flood A Transdermal Nicotine Patch Is Not Effective for Postoperative Pain Management in Smokers: A Pilot Dose-Ranging Study Anesth. Analg., December 1, 2009; 109(6): 1987 - 1991. [Abstract] [Full Text] [PDF]

				N. L. Benowitz Nicotine and Postoperative Management of Pain Anesth. Analg., September 1, 2008; 107(3): 739 - 741. [Full Text] [PDF]