Yalla Bharat, Khanna Puneet, Sarkar Soumya, Lal Deepika, Maheshwari Ankita, Gupta Manish, Garg Bhavuk
Department of Anaesthesiology, Pain Medicine, and Critical Care, AIIMS, New Delhi, India.
Department of Anaesthesiology, AIIMS, Kalyani, West Bengal, India.
Indian J Anaesth. 2025 Jul;69(7):664-674. doi: 10.4103/ija.ija_1216_24. Epub 2025 Jun 12.
Nicotine replacement therapy (NRT) has emerged as a potential intervention for managing perioperative pain. However, their effectiveness remains unclear, as previous studies neither considered the effect of the route of administration nor differentiated the effect between smokers and non-smokers. 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 a placebo.
We performed a meta-analysis of randomised controlled trials (RCTs) comparing the effects of transdermal nicotine and placebo on postoperative pain. Databases of MEDLINE, EMBASE, CENTRAL, CINAHL, Google Scholar, Web of Science, and the Cochrane Central Register of Controlled Trials were searched. This systematic review and meta-analysis followed the PRISMA guidelines. The findings were evaluated using forest plots and expressed as relative risk (RR) or mean difference (MD) for primary and secondary outcomes.
Twelve studies included in the analysis showed no significant difference in pain scores (NRS) at 24 h between the two groups, with an MD -0.24 [95% confidence interval (CI): -0.55, 0.07; P = 0.13] (I = 77%, < 0.00001), and there was no significant difference in postoperative opioid consumption (morphine equivalent) MD -0.92 (95% CI: -5.04, 3.21; = 0.66) (I = 23%, = 0.27). Similarly, the two groups had no significant differences in the time to first rescue analgesia, postoperative nausea and vomiting (PONV), or patient satisfaction. However, the required information size was not achieved for the outcomes of postoperative opioid requirement, reduction in postoperative pain, PONV, and the time for rescue analgesia.
The perioperative transdermal nicotine patch did not significantly reduce postoperative pain scores compared with placebo. There appears to be a significant reduction in smokers, but the evidence is inadequate to conclude this finding.
尼古丁替代疗法（NRT）已成为一种管理围手术期疼痛的潜在干预措施。然而，其有效性仍不明确，因为既往研究既未考虑给药途径的影响，也未区分吸烟者和非吸烟者之间的效果差异。本系统评价和荟萃分析旨在确定围手术期经皮尼古丁贴片与安慰剂相比，对吸烟者和非吸烟者术后疼痛的影响。
我们对比较经皮尼古丁与安慰剂对术后疼痛影响的随机对照试验（RCT）进行了荟萃分析。检索了MEDLINE、EMBASE、CENTRAL、CINAHL、谷歌学术、科学网和Cochrane对照试验中央注册库等数据库。本系统评价和荟萃分析遵循PRISMA指南。使用森林图对结果进行评估，并将主要和次要结局表示为相对风险（RR）或平均差（MD）。
纳入分析的12项研究显示，两组在24小时时的疼痛评分（NRS）无显著差异，MD为-0.24 [95%置信区间（CI）：-0.55，0.07；P = 0.13]（I² = 77%，P < 0.00001），术后阿片类药物消耗量（吗啡当量）也无显著差异，MD为-0.92（95%CI：-5.04，3.21；P = 0.66）（I² = 23%，P = 0.27）。同样，两组在首次补救镇痛时间、术后恶心呕吐（PONV）或患者满意度方面也无显著差异。然而，术后阿片类药物需求量、术后疼痛减轻、PONV和补救镇痛时间等结局未达到所需的信息量。
与安慰剂相比，围手术期经皮尼古丁贴片并未显著降低术后疼痛评分。吸烟者似乎有显著降低，但证据不足以得出这一结论。
