Intranasal Nicotine Increases Postoperative Nausea and is Ineffective in Reducing Pain Following Laparoscopic Bariatric Surgery in Tobacco-Naïve Females: A Randomized, Double Blind Trial

• Published in: Obesity surgery Vol. 25; no. 3; pp. 506 - 513
• Main Authors: Weingarten, Toby N., McGlinch, Brian P., Liedl, Lavonne, Kendrick, Michael L., Kellogg, Todd A., Schroeder, Darrell R., Sprung, Juraj
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.03.2015; Springer Nature B.V
• Subjects: Administration, Intranasal; Adult; Analgesics - administration & dosage; Antiemetics - administration & dosage; Bariatric Surgery - adverse effects; Bariatric Surgery - methods; Chemoprevention; Double-Blind Method; Female; Gastrointestinal surgery; Humans; Intraoperative Period; Laparoscopy - adverse effects; Laparoscopy - methods; Medicine; Medicine & Public Health; Middle Aged; Nausea; Nicotine; Nicotine - administration & dosage; Obesity; Obesity, Morbid - drug therapy; Obesity, Morbid - epidemiology; Obesity, Morbid - surgery; Original Contributions; Pain; Pain, Postoperative - drug therapy; Pain, Postoperative - epidemiology; Postoperative Nausea and Vomiting - drug therapy; Postoperative Nausea and Vomiting - epidemiology; Surgery; Tobacco Use; Treatment Failure; Postoperative pain; Laparoscopic bariatric surgery; Nicotine
• ISSN: 0960-8923; 1708-0428
• DOI: 10.1007/s11695-014-1431-7

Background Nicotine is a known analgesic. Our primary aim was to test the hypothesis that intranasal nicotine administered intraoperatively reduces the need for postoperative opioids. The secondary outcomes included evaluation of both postoperative pain and nausea and vomiting (PONV). Material and Methods Nonsmoking female patients undergoing laparoscopic bariatric operations were randomized to receive either 3 mg intranasal nicotine ( N  = 42) or placebo spray ( N  = 47) at the conclusion of surgery. Postoperative opioid use converted to intravenous morphine equivalents (iv MEQ) and PONV rates were recorded during both the recovery room postanesthesia care unit (PACU) stay and the first 24 postoperative hours. All patients received multimodal antiemetic prophylaxis. Results Total iv MEQ were not significantly reduced during the PACU stay in patients receiving nicotine (median [interquartile range (IQR)], 5.3 [0, 10.0] mg for nicotine vs. 5.2 [0, 12.7] mg for placebo, one-tailed P  = 0.414) or for the first 24 h following PACU discharge (39.6 [20.0, 52.5] mg for nicotine vs. 32.7 [20.3, 51.3] mg for placebo, one-tailed P  = 0.752). For the combined period (PACU + 24-h post-PACU discharge), iv MEQ were 45.8 [27.0, 58.6] mg for nicotine and 39.4 [23.5, 60.0] mg for placebo, one-tailed P  = 0.801. Compared to placebo, a higher percentage of patients administered nicotine received antiemetics in the PACU (57.1 vs. 25.5 %, P  = 0.002). Conclusion Intraoperative intranasal nicotine did not exhibit opioid-sparing effect in nonsmoking bariatric female patients. Despite antiemetic prophylaxis, the use of nicotine was associated with the higher frequency of the use of rescue antiemetics in PACU.