Olson Luke C, Hong Daewha, Conell-Price Jessamyn S, Cheng Sean, Flood Pamela
Department of Anesthesiology, Columbia University Medical Center, New York, New York, USA.
Anesth Analg. 2009 Dec;109(6):1987-91. doi: 10.1213/ANE.0b013e3181bd1612.
Nicotine has an antinociceptive effect in animal models. The analgesic effect in humans has been examined, but studies have had mixed results. A proposed etiology is variability in chronic nicotine exposure because of differences in tobacco smoking rates and second-hand smoke exposure. In this study, we examined the postoperative analgesic effect of a transdermal nicotine patch in smokers in a parallel design to a previous study in nonsmokers.
We conducted a randomized, double-blind, prospective, placebo-controlled trial of 28 patients undergoing abdominal or pelvic surgery who required patient-controlled analgesia and an overnight hospital stay. Before anesthetic induction, a transdermal nicotine patch was applied (0, 5, 10, or 15 mg). The primary outcome variable was postoperative pain reported over the first hour and over the next 5 days using a standard numerical rating scale. Secondary outcome variables were pain medication use, hemodynamic values, nausea, and sedation.
Patients treated with nicotine reported higher pain scores than those treated with placebo over the first hour after surgery (P < 0.01, average numerical rating scale increase = 0.67) and there was no difference between groups in the subsequent 5 days (P > 0.05). There was no significant dose effect. Diastolic blood pressure in the first hour was higher in the placebo group compared with the nicotine-treated group (P < 0.01, average increase = 11 mm Hg). There was no difference in nausea or sedation.
Transdermal nicotine, 5-15 mg, failed to relieve postoperative pain or reduce opioid use in smokers.
尼古丁在动物模型中具有抗伤害感受作用。其对人类的镇痛效果已得到研究，但结果不一。一种推测的病因是由于吸烟率和二手烟暴露的差异导致慢性尼古丁暴露存在变异性。在本研究中，我们采用与之前针对非吸烟者的研究平行的设计，研究了经皮尼古丁贴片对吸烟者术后的镇痛效果。
我们对28例接受腹部或盆腔手术且需要患者自控镇痛并住院过夜的患者进行了一项随机、双盲、前瞻性、安慰剂对照试验。在麻醉诱导前，应用经皮尼古丁贴片（0、5、10或15毫克）。主要结局变量是术后第1小时及接下来5天使用标准数字评分量表报告的术后疼痛。次要结局变量包括止痛药物使用、血流动力学值、恶心和镇静情况。
与安慰剂组相比，尼古丁治疗组患者在术后第1小时报告的疼痛评分更高（P<0.01，数字评分量表平均增加 = 0.67），且在随后5天两组之间无差异（P>0.05）。不存在显著的剂量效应。安慰剂组在术后第1小时的舒张压高于尼古丁治疗组（P<0.01，平均增加 = 11毫米汞柱）。恶心或镇静情况无差异。
5 - 15毫克的经皮尼古丁未能缓解吸烟者的术后疼痛或减少阿片类药物的使用。
