Effect of Nicotine Replacement Therapy on Perioperative Pain Management and Opioid Requirement in Abstinent Tobacco Smokers Undergoing Spinal Fusion: A Double-blind Randomized Controlled Trial.
Study Goal
The researchers aimed to determine whether a high-dose transdermal nicotine patch (21 mg/24 h) could reduce postoperative pain and opioid requirements in abstinent tobacco smokers undergoing spinal fusion.
Results Summary
The study found that the nicotine group had lower postoperative pain scores and reduced morphine consumption compared to the placebo group, with significant correlations between nicotine levels, cigarette use, and pain/opioid requirements.
Population
Abstinent tobacco smokers undergoing single-level spinal fusion (n=100).
Effective Dosage
21 mg/24 h transdermal nicotine patch.
Duration
Applied 24 hours before surgery until 48 hours after surgery.
Interactions
None mentioned
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
high dose (21 mg/24 h) transdermal nicotine (TDN) patch | decrease | postoperative pain and opioid requirements | abstinent tobacco smokers undergoing single-level spinal fusion | - | would reduce | #1 |
nicotine replacement therapy | decrease | these complications | tobacco users | - | has been recommended to minimize | #2 |
acute abstinence from smoking during hospitalization | increase | postoperative pain | tobacco users | - | can increase | #3 |
acute abstinence from smoking during hospitalization | decrease | pain thresholds | tobacco users | - | can lower | #4 |
acute abstinence from smoking during hospitalization | neutral | pain management | tobacco users | - | can disrupt | #5 |
acute abstinence from smoking during hospitalization | increase | hyperalgesia | tobacco users | - | can trigger | #6 |
TDN patches (21 mg/24 h) | decrease | postoperative pain | abstinent tobacco smokers undergoing spinal fusion | - | reduced | #7 |
TDN patches (21 mg/24 h) | decrease | opioid requirements | abstinent tobacco smokers undergoing spinal fusion | - | reduced | #8 |
nicotine treatment | decrease | postoperative pain scores at rest and on movement | abstinent tobacco smokers undergoing single-level spinal fusion | - | were lower | #9 |
nicotine treatment | decrease | postoperative morphine consumption | abstinent tobacco smokers undergoing single-level spinal fusion | 9.92 ± 4.0 vs. 15.9 ± 5.0 mg | was lower | #10 |
number of cigarettes smoked per day | increase | postoperative pain scores at rest | abstinent tobacco smokers undergoing single-level spinal fusion | r = 0.4553 | positive correlation | #11 |
number of cigarettes smoked per day | increase | postoperative pain scores during movement | abstinent tobacco smokers undergoing single-level spinal fusion | - | positive correlation | #12 |
serum nicotine concentration | decrease | postoperative morphine consumption | abstinent tobacco smokers undergoing single-level spinal fusion | r = -0.3664 | negative correlation | #13 |
BACKGROUND: Smoking negatively impacts postoperative outcomes but acute abstinence from smoking during hospitalization can increase postoperative pain, lower pain thresholds, disrupt pain management, and trigger hyperalgesia due to abrupt nicotine withdrawal in tobacco users. Nicotine replacement therapy has been recommended to minimize these complications. We hypothesized that a high dose (21 mg/24 h) transdermal nicotine (TDN) patch would reduce postoperative pain and opioid requirements. METHODS: One hundred abstinent tobacco smokers undergoing single-level spinal fusion were randomized into placebo (n=50) and nicotine treatment (n=50) groups. Placebo and TDN patches were applied 24 hours before surgery until 48 hours after surgery. Primary outcomes were postoperative pain scores and opioid (morphine) consumption, and serum nicotine levels. The relationship between daily tobacco use and pain and opioid requirements, and between serum nicotine levels and morphine consumption, were assessed. RESULTS: Postoperative pain scores at rest and on movement were lower in the nicotine group than in the placebo group at 6 hours, 12 hours, and 24 hours after surgery (P<0.05). Postoperative morphine consumption was lower in the nicotine group than in the placebo group (9.92 ± 4.0 vs. 15.9 ± 5.0 mg, respectively; P=0.0002). There was a positive correlation between the number of cigarettes smoked per day and postoperative pain scores at rest (r = 0.4553; P = 0.0001) and during movement and a negative correlation between serum nicotine concentration and postoperative morphine consumption (r =-0.3664; P = 0.0089). CONCLUSIONS: TDN patches (21 mg/24 h) reduced postoperative pain and opioid requirements in abstinent tobacco smokes undergoing spinal fusion.