Background & Aims

Effective pain management during the perioperative phase is essential not only for ensuring patient comfort but also for improving surgical outcomes and enabling a more seamless recovery process. Nicotine Replacement Therapy (NRT) has emerged as a potential intervention for managing perioperative pain and presents a novel approach for pain relief that is available in multiple forms. Among them, nicotine patches offer slow and sustained release of nicotine, with peak concentrations occurring hours after application; however, their effectiveness remains inconclusive. This systematic review and meta-analysis aimed to determine the effect of a perioperative transdermal nicotine patch on postoperative pain in both smokers and non-smokers compared with placebo.

Methods

A literature search was performed using electronic databases, such as PubMed, Google Scholar, Embase, Cochrane Reviews, MEDLINE, and the US Clinical Registry. Randomized controlled trials comparing the analgesic effect of a transdermal nicotinepatch with a placebo for postoperative pain were included. The primary outcome was postoperative pain score (NRS-Numerical Rating Scale) at 24 h; secondary outcomes were time to first rescue analgesia, incidence of postoperative nausea and vomiting (PONV), and patient satisfaction. Inverse variance and Mantel-Haenszel statistical analysis methods were used for continuous and dichotomous data, respectively.All results were quantitatively analyzed using a random-effects model.

Results

Twelve studies with 735 patients were included in both groups and showed no significant difference in pain scores (NRS) at 24 h between the two groups, with an MD of -0.25 (95% CI -0.56 to 0.06, p<0.008;(I2=96%, p<0.00001).However, subgroup analysis, includingsmokers alone, showed a significant reduction in postoperative pain scores (NRS) at 24 h with an MD of of-0.56 (95% CI -0.62 to 0.51, p<0.00001),(I2=0%, p=0.54), and there was no significant difference in postoperative opioid consumption ( morphine equivalent) MD -0.92 (95% CI -5.04 to 3.21, p=0.66);(I2=23%, p=0.27). Similarly, there were no significant differences in the time to first rescue analgesia, incidence of PONV, or patient satisfaction between the two groups.

Conclusions

The perioperative transdermal nicotine patch effectively reduced postoperative pain in smokers, contrasting with non-smokers who exhibited no significant differences from the placebo group. These results underscore the need for extensive randomized trials to solidify the observed analgesic benefits in smokers and ascertain the broader applications of nicotine patches in managing postoperative pain across diverse patient populations.

References

dwdw

Presenting Author

Dr. Puneet Khanna

Poster Authors

Puneet Khanna, MD

MD

All India Institute of Medical Sciences, New Delhi

Lead Author

Deepika Lal

PhD

All India Institute of Medical Sciences, New Delhi

Lead Author

Bharat Yalla

MD

All India Institute of Medical Sciences, New Delhi

Lead Author

ANKITA MAHESHWARI

All India Institute of Medical Sciences, New Delhi

Lead Author

Manish Gupta

PhD

All India Institute of Medical Sciences, New Delhi

Lead Author

Bhavuk Garg

MS

All India Institute of Medical Sciences, New Delhi

Lead Author

Akhil Kant Singh

MD

All India Institute of Medical Sciences, New Delhi

Lead Author

Topics

  • Systematic Reviews/Meta-Analysis