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Transdermal nicotine for analgesia after radical retropubic prostatectomy.

Publication ,  Journal Article
Habib, AS; White, WD; El Gasim, MA; Saleh, G; Polascik, TJ; Moul, JW; Gan, TJ
Published in: Anesth Analg
September 2008

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.

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Published In

Anesth Analg

DOI

EISSN

1526-7598

Publication Date

September 2008

Volume

107

Issue

3

Start / End Page

999 / 1004

Location

United States

Related Subject Headings

  • Prostatectomy
  • Prospective Studies
  • Placebos
  • Pain, Postoperative
  • Nicotinic Agonists
  • Nicotine
  • Morphine
  • Middle Aged
  • Male
  • Humans
 

Citation

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Habib, A. S., White, W. D., El Gasim, M. A., Saleh, G., Polascik, T. J., Moul, J. W., & Gan, T. J. (2008). Transdermal nicotine for analgesia after radical retropubic prostatectomy. Anesth Analg, 107(3), 999–1004. https://doi.org/10.1213/ane.0b013e31816f2616
Habib, Ashraf S., William D. White, Magdi A. El Gasim, Gamal Saleh, Thomas J. Polascik, Judd W. Moul, and Tong J. Gan. “Transdermal nicotine for analgesia after radical retropubic prostatectomy.Anesth Analg 107, no. 3 (September 2008): 999–1004. https://doi.org/10.1213/ane.0b013e31816f2616.
Habib AS, White WD, El Gasim MA, Saleh G, Polascik TJ, Moul JW, et al. Transdermal nicotine for analgesia after radical retropubic prostatectomy. Anesth Analg. 2008 Sep;107(3):999–1004.
Habib, Ashraf S., et al. “Transdermal nicotine for analgesia after radical retropubic prostatectomy.Anesth Analg, vol. 107, no. 3, Sept. 2008, pp. 999–1004. Pubmed, doi:10.1213/ane.0b013e31816f2616.
Habib AS, White WD, El Gasim MA, Saleh G, Polascik TJ, Moul JW, Gan TJ. Transdermal nicotine for analgesia after radical retropubic prostatectomy. Anesth Analg. 2008 Sep;107(3):999–1004.

Published In

Anesth Analg

DOI

EISSN

1526-7598

Publication Date

September 2008

Volume

107

Issue

3

Start / End Page

999 / 1004

Location

United States

Related Subject Headings

  • Prostatectomy
  • Prospective Studies
  • Placebos
  • Pain, Postoperative
  • Nicotinic Agonists
  • Nicotine
  • Morphine
  • Middle Aged
  • Male
  • Humans