Efficacy of a Transdermal Nicotine Patch in Pain Relief after Arthroscopic Shoulder Surgery: A Randomized Controlled Trial
Wanwipha Malaithong MD*, Sithapan Munjupong MD*
Affiliation : * Department of Anesthesiology, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
Background : Perioperative nicotine administration was suggested to reduce pain scores and opioid consumption in visceral
pain control. However, there is no evidence to support the analgesic effect of nicotine administration in postoperative somatic
pain.
Objective : To study the efficacy of transdermal nicotine patches (TNP) in postoperative somatic pain relief by assessing
numerical rating scale (NRS) scores and opioid consumption.
Material and Method: A prospective, double-blind, placebo-controlled study was conducted in 46 patients, who received
general anesthesia for elective arthroscopic shoulder surgery. All participants were randomly allocated to receive a patch
of 7 mg nicotine or placebo before induction of anesthesia and remaining for 24 hours after surgery. Participants and
assessors were blinded to allocation. Average pain score and intravenous morphine patient-controlled analgesia (PCA)
consumption were assessed at 1 hour and 24 hours postoperatively.
Results : There was no significant difference in mean NRS and average opioid consumption at 1 hour and 24 hours
postoperatively between controlled and treatment group. However, the significant reduction in average NRS from baseline
at 1 hour and 24 hours postoperatively were found in both groups (p<0.001).
Conclusion : Administration of a 7 mg TNP did not significantly reduce in pain scores and postoperative opioid consumption
compared with transdermal placebo during perioperative elective arthroscopic shoulder surgery.
Keywords : Transdermal nicotine patch, Postoperative pain control, Multimodal analgesia, Arthroscopic shoulder surgery
