Effect of Nicotine Replacement Therapy on Pain & Opioids in Spinal Fusion Abstinent Smokers: RCT

Background & Aims

Smoking rates in India dropped from 27% to 24%, but the absolute numbers of male smokers aged 15–69 increased notably1. When such patients get hospitalized for undergoing surgery they are restricted from smoking inside the hospital premises. Hence, this forced abstinence from smoking might trigger nicotine withdrawal, results in hyperalgesia or lower pain threshold after surgical procedures during the hospital stays2-4. Nicotine found to have an analgesic property5. Previous studies on the effect of nicotine replacement therapy with transdermal patch have shown no benefit in the improvement of pain scores or reduction in opioid requirement in smokers6,7 .Therefore, the aim of the study is to compare the effect of nicotine replacement therapy on pain and perioperative opioid requirement in abstinent tobacco smokers undergoing spinal fusion.

Methods

A total of 100 abstinent tobacco smokers planned for spinal fusion were recruited and randomized into Group A (n=50) and Group B (n=50). Transdermal nicotine patch (21 mg) was applied one day prior to surgery till 48 hours after completion of surgery in group A and transdermal patch without nicotine were applied in group B. PCA pump was attached postoperatively with lock out interval of 10 mins with an hourly maximum of 3 mg morphine. Perioperative baseline data, NRS score with post-operative morphine consumption were recorded. Nicotine concentration was measured from pre and postoperative serum samples using ELISA.

Results

The mean age ± SD of the study participants of Group A and Group B patients was 45.4 ± 14.5 and 46.84 ± 15.8 years, respectively. No significant difference was observed in both the groups with respect to age, BMI, comorbidity, ASA grade and perioperative baseline variables. The NRS score was lower in Group B. Two- sample t test with equal variance found the significant effect in NRS score. Wilcoxon rank-sum (Mann- Whitney) test found the significant effect (<0.001) of nicotine concentration in the postoperative group. Spearman’s rho test founds the negative correlation of postoperative morphine consumption with nicotine concentration in both the group.

Conclusions

The administration of transdermal nicotine patch (21 mg) one day prior to surgery resulted in the reduction of pain scores. Additionally, there was non-significant reduction in postoperative opioid requirement.

References

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5.Cosgrove KP, Esterlis I, McKee S, Bois F, Alagille D, Tamagnan GD, et al. Beta2* nicotinic acetylcholine receptors modulate pain sensitivity in acutely abstinent tobacco smokers. Nicotine Tob Res. 2010 May;12(5):535–9.
6.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.
7.Turan A, White PF, Koyuncu O, Karamanlio?lu B, Kaya G, Apfel CC. Transdermal Nicotine Patch Failed to Improve Postoperative Pain Management. Anesth Analg. 2008 Sep;107(3):1011–7

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