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

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.