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ANALGESIA

Transdermal Nicotine for Analgesia After Radical Retropubic Prostatectomy

Ashraf S. Habib, MBBCh, MSc, FRCA^*, William D. White, MPH^*, Magdi A. El Gasim, MD^*, Gamal Saleh, MD^*, Thomas J. Polascik, MD, Judd W. Moul, MD, and Tong J. Gan, MB, FRCA^*

From the *Department of Anesthesiology, Division of Urologic Surgery and Duke Prostate Center, Department of Surgery, Duke University Medical System, Durham, North Carolina.

Address correspondence and reprint requests to Ashraf S. Habib, MBBCh, MSc, FRCA, Duke University Medical System, Box 3094, Durham, North Carolina. Address e-mail to habib001{at}mc.duke.edu.

Abstract

BACKGROUND: Previous animal and human studies suggested that nicotine might have an antinociceptive effect. We hypothesized that the preoperative application of a 7 mg nicotine patch would result in reduced postoperative analgesic requirements in patients undergoing radical retropubic prostatectomy (RRP) under general anesthesia.

METHODS: Nonsmokers undergoing RRP under general anesthesia were enrolled in this prospective, double-blind, placebo-controlled study. Patients were randomly assigned to receive a patch of 7 mg nicotine or placebo applied behind the ear 30–60 min before induction of anesthesia. The anesthetic technique was standardized. Postoperative analgesia was provided with a standardized morphine patient-controlled analgesia and 6 hourly ketorolac 15 mg IV. Data were collected in the postanesthesia care unit and at 6, 12, and 24 h after surgery.

RESULTS: Ninety patients were included in the analysis: 44 in the nicotine group and 46 in the placebo group. The groups did not differ significantly with respect to age, height, weight, ASA class, length of surgery, or amounts of intraoperative fentanyl received. The nicotine group showed significantly lower cumulative morphine consumption at 24 h (mean ± sd): 33.3 ± 30.8 mg vs 44.7 ± 26.4 mg (P = 0.0059, time x treatment P = 0.0031). However, the repeated measures tests found no difference in amount of pain reported on coughing or at rest, either as treatment effects or in interaction with time. In post hoc comparisons, there was no significant difference in amount of pain reported on coughing or at rest at any of the times assessed. There were also no significant differences between the groups in the incidence of postoperative nausea and vomiting or the need for rescue antiemetics. However, the maximum nausea verbal rating scale score was higher in the nicotine than in the placebo group (median, 25th to 75th percentiles = 4, 0–6 vs 0, 0–6, P = 0.0158). There was a significant negative correlation between the 24 h plasma nicotine levels and postoperative morphine consumption in the postanesthesia care unit (P = 0.049), as well as at 6, 12, and 24 h (P = 0.002).

CONCLUSION: The preoperative application of a 7 mg nicotine patch resulted in a significant reduction in opioid consumption in patients undergoing RRP under general anesthesia. Despite this reduction in opioid use, there was no reduction in pain scores or postoperative nausea and vomiting with the use of transdermal nicotine.

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]