How Effective Is Nicotine for Post-Operative Pain?

PORTLAND, OR — With acute pain a frequent problem after surgical procedures, nicotine has been explored as an adjunctive medication for management of postoperative pain.

A research analysis published in the Cochrane Database of Systematic Reviews (CDSR) sought to determine the effectiveness of transdermal or intranasal nicotine administration on postoperative pain, opioid analgesic use and opioid-related adverse events.1

For the study, Portland, OR, VAMC-led researchers examined MEDLINE from 1966 to March 2014, the Cochrane Central Register of Controlled Trials and EMBASE from 1980 to 2014, as well as databases of ongoing trials. Included were randomized, placebo-controlled clinical trials that evaluated the effects of perioperative (pre-, intra- or postoperative) administration of nicotine on postoperative pain, opioid use and opioid-related adverse events.

Results indicated that nine trials involving 666 participants evaluated nicotine for postoperative pain, finding that nicotine might reduce postoperative pain scores at 24 hours by a small amount, compared with placebo.

The effect on pain at one hour and 12 hours postoperatively was less certain because it included very low quality evidence.

“The effect of nicotine on postoperative opioid use was uncertain due to small number of participants in the studies,” according to study authors, who noted that nicotine probably increases the risk of postoperative nausea, although not vomiting.

The study noted that three trials assessed sedation but did not have enough high-quality evidence to reach a determination. The effect is very uncertain, due to the very low quality of evidence.

Based on evidence of generally low quality, nicotine may reduce postoperative pain at 24 hours compared with placebo, but the effects were relatively small (less than 1 point on a 10 point pain scale) and there was substantial heterogeneity in the results of our analyses,” study authors concluded. “Nicotine does not appear to reduce postoperative use of opioids or opioid-related adverse events but probably increases the risk of nausea. More research is needed to determine the effectiveness of nicotine for postoperative pain and to understand the optimal timing, dose, and method of delivery of nicotine.”

  1. Matthews AM, Fu R, Dana T, Chou R. Intranasal or transdermal nicotine for the treatment of postoperative pain. Cochrane Database Syst Rev. 2016 Jan 12;1:CD009634. [Epub ahead of print] Review. PubMed PMID: 26756459.

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