Randomised trial of intranasal nicotine and postoperative pain, nausea and vomiting in non-smoking women

Christopher J. Jankowski, Toby N. Weingarten, David P. Martin, Francis X. Whalen, John B. Gebhart, Lavonne M. Liedl, David R. Danielson, Ashley M. Nadeau, Darrell R. Schroeder, David O. Warner, Juraj Sprung

Research output: Contribution to journalArticle

13 Scopus citations

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 3mg 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. Conclusion: 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.

Original languageEnglish (US)
Pages (from-to)585-591
Number of pages7
JournalEuropean Journal of Anaesthesiology
Volume28
Issue number8
DOIs
StatePublished - Aug 1 2011

Keywords

  • Gynaecological surgery
  • Nicotine
  • Postoperative analgesia
  • Postoperative nausea and vomiting
  • Randomised controlled trial

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

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    Jankowski, C. J., Weingarten, T. N., Martin, D. P., Whalen, F. X., Gebhart, J. B., Liedl, L. M., Danielson, D. R., Nadeau, A. M., Schroeder, D. R., Warner, D. O., & Sprung, J. (2011). Randomised trial of intranasal nicotine and postoperative pain, nausea and vomiting in non-smoking women. European Journal of Anaesthesiology, 28(8), 585-591. https://doi.org/10.1097/EJA.0b013e328344d998