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Luo Y, Yang Y, Schneider C, Balle T. The Anti-Nociceptive Effects of Nicotine in Humans: A Systematic Review and Meta-Analysis. Pharmaceuticals (Basel) 2023; 16:1665. [PMID: 38139792 PMCID: PMC10747127 DOI: 10.3390/ph16121665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 10/23/2023] [Accepted: 11/24/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Pain can have a serious impact on a patient's physical, mental, and social health, often causing their quality of life to decline. Various nicotine dosage forms, such as nicotine patches and nasal spray, have been developed and used as analgesics in clinical settings. However, there is controversy over the anti-nociceptive effects of nicotine among different clinical trials. The purpose of this meta-analysis is to quantify the analgesic effect of nicotine patches, nicotine nasal spray, and tobacco smoking on pain in humans. METHODS Relevant articles published in English prior to July 2023 were identified using the PubMed, Cochrane Library, and Embase online databases in accordance with PRISMA (2020) guidelines. Two reviewers independently screened and selected studies, extracted data, and assessed the quality of the included studies using version 2 of the Cochrane risk-of-bias tool for randomized trials (RoB 2). RStudio was used for data synthesis, heterogeneity assessment, sensitivity analysis, publication bias assessment, trim-and-fill analyses, and generating forest plots. RESULTS Sixteen eligible articles, including k = 5 studies of pain tolerance (n = 210), k = 5 studies of pain threshold (n = 210), and k = 12 studies of pain scores (N = 1249), were included for meta-analysis. Meta-analytic integration for pain threshold (Hedges' g = 0.28, 95% CI = 0-0.55, Z = 1.99, p = 0.05) and pain tolerance (Hedges' g = 0.32, 95% CI = 0.05-0.59, Z = 2.30, p = 0.02) revealed that nicotine administered via tobacco smoke generated acute analgesic effects to thermal stimuli. Meta-analytic integration for pain scores revealed that nicotine had a weak anti-nociceptive effect on postoperative pain of -0.37 (95% CI = -0.77 to 0.03, Z = -1.80) but with no statistical significance (p = 0.07). In addition, a limited number of included studies revealed that long-term smoking produced hyperalgesia that may be characterized as small to medium in magnitude (Hedges' g = 0.37, 95% CI = 0.29-0.64, Z = 5.33, p < 0.01). CONCLUSION These results help to clarify the mixed outcomes of trials and may ultimately inform the treatment of pain. We observed that acute nicotine administration prolonged the laboratory-induced pain threshold and tolerance time and may mildly relieve postoperative pain. In addition, long-term tobacco smoking may have a nociceptive effect on different types of chronic pain. More research is needed to determine the anti-nociceptive effects of nicotine in humans, and to understand the optimal timing, dose, and method of delivery of nicotine.
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Affiliation(s)
- Yujia Luo
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (Y.L.)
- Brain and Mind Centre, The University of Sydney, 94 Mallet Street, Camperdown, NSW 2050, Australia
| | - Yating Yang
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (Y.L.)
- Brain and Mind Centre, The University of Sydney, 94 Mallet Street, Camperdown, NSW 2050, Australia
| | - Carl Schneider
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (Y.L.)
| | - Thomas Balle
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (Y.L.)
- Brain and Mind Centre, The University of Sydney, 94 Mallet Street, Camperdown, NSW 2050, Australia
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da Silva Barbirato D, de Melo Vasconcelos AF, Dantas de Moraes SL, Pellizzer EP, do Egito Vasconcelos BC. Analgesic potential of transdermal nicotine patch in surgery: a systematic review and meta-analysis of randomised placebo-controlled trials. Eur J Clin Pharmacol 2023; 79:589-607. [PMID: 36947193 DOI: 10.1007/s00228-023-03475-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 03/09/2023] [Indexed: 03/23/2023]
Abstract
OBJECTIVES We aimed (1) to systematically review the efficacy of transdermal nicotine patches (NP) for postoperative analgesia, (2) to establish the current quality of evidence and assist clinical decision-making on the subject, and (3) to identify methodological limitations and the need for more well-designed studies. MATERIALS AND METHODS We searched six electronic databases, protocol records, and other sources without date or language restriction until March 2022. To develop the search strategy, we formulated a clinical question by using the PICOD method. Eligibility criteria included randomised placebo-controlled trials on the analgesic potential of NP for surgical procedures. This systematic review followed the PRISMA 2020 statement, and we registered the protocol in PROSPERO (#CRD42020205956). RESULTS We included 10 randomised placebo-controlled trials (535 patients). The NP administered before induction of anaesthesia and at beginning of surgery reduced the pain immediately after surgery (-0.38; 95% confidence interval [CI]: -0.73 to -0.02), and 6 h (-0.34; 95% CI: -0.68 to -0.01), 12 h (-0.43; 95% CI: -0.71 to -0.15) and 24 h (-0.35; 95%CI: -0.59 to -0.10) after surgery, compared with the placebo patch (PP) group. Sensitivity testing suggests that opioid use could underestimate NP analgesia. Late demand for the first analgesic and consumption of rescue analgesics tended to be lower in the NP group. CONCLUSIONS The current findings suggest, with low certainty of evidence, the analgesic potential of NP for surgical procedures. CLINICAL RELEVANCE Perioperative use of NP significantly improved postoperative pain, even when opioids were administered or prescribed. Nevertheless, the clinical relevance should be interpreted with caution, owing to the effect sizes of the summary measures and methodological issues. The analgesic potential of NP as an adjuvant therapy to regulate pain and acute inflammation may offer certain clinical advantages, thus warranting further investigation.
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Affiliation(s)
- Davi da Silva Barbirato
- Division of Oral and Maxillofacial Surgery, Dental School, University of Pernambuco (UPE), Arnóbio Marques St., 310, Recife, PE, 50100-130, Brazil
| | | | | | - Eduardo Piza Pellizzer
- Department of Dental Materials and Prosthodontics, São Paulo State University (UNESP), Araçatuba, Brazil
| | - Belmiro Cavalcanti do Egito Vasconcelos
- Division of Oral and Maxillofacial Surgery, Dental School, University of Pernambuco (UPE), Arnóbio Marques St., 310, Recife, PE, 50100-130, Brazil.
- Oral and Maxillofacial Surgery at Hospital da Restauração, Recife, PE, Brazil.
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Vega Palma MI, Klivinyi C, Lampl T, Lang-Illievich K, Bornemann-Cimenti H, Szilagyi IS. The Effect of Smoking Cessation on Acute Pain: A Systematic Review. Pain Ther 2023; 12:67-79. [PMID: 36478326 PMCID: PMC9845453 DOI: 10.1007/s40122-022-00462-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 11/17/2022] [Indexed: 12/13/2022] Open
Abstract
Smoking is a known risk factor for developing various pain-related disorders. However, acute pain often triggers the craving for cigarette consumption, resulting in a positive feedback mechanism. In addition, there is evidence of decreased pain tolerance during the early stages of abstinence. Therefore, in this study, we aimed to investigate whether a period of decreased pain tolerance and increased pain intensity occurs during smoking cessation. A systematic literature search was conducted through PubMed and Web of Science databases for controlled studies investigating the influence of smoking cessation on acute (defined as pain presentation of < 3 months) and postoperative pain. The outcomes of interest included pain perception threshold, pain tolerance, pain intensity, and postoperative opioid requirements. The search strategy yielded 1478 studies, of which 13 clinical studies met our inclusion criteria. The included studies collectively represented data from 1721 participants from four countries. Of these, 43.3% of the included individuals were females. The mean age of the included subjects was 44.2 ± 8.2 years. The duration of smoking cessation varied considerably. The shortest duration was 2 h; others investigated the effect after more than 1 month of smoking cessation. Smokers had a history of 14.6 ± 9.9 years of nicotine abuse. The mean number of daily smoked cigarettes was 17.5 ± 10.3. Most studies examined in this systematic review show a negative influence of smoking cessation on acute pain. However, the affected pain modalities, the duration of the altered pain perception, and whether male and female smokers are equally affected could not be ascertained due to high heterogeneity and few available studies.
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Affiliation(s)
- Matias Ignacio Vega Palma
- Department of Anaesthesiology and Intensive Care Medicine, Medical University of Graz, Auenbruggerplatz 5/5, 8036 Graz, Austria
| | - Christoph Klivinyi
- Department of Anaesthesiology and Intensive Care Medicine, Medical University of Graz, Auenbruggerplatz 5/5, 8036 Graz, Austria
| | - Thomas Lampl
- Department of Anaesthesiology and Intensive Care Medicine, Medical University of Graz, Auenbruggerplatz 5/5, 8036 Graz, Austria
| | - Kordula Lang-Illievich
- Department of Anaesthesiology and Intensive Care Medicine, Medical University of Graz, Auenbruggerplatz 5/5, 8036 Graz, Austria
| | - Helmar Bornemann-Cimenti
- Department of Anaesthesiology and Intensive Care Medicine, Medical University of Graz, Auenbruggerplatz 5/5, 8036 Graz, Austria
| | - Istvan S. Szilagyi
- Department of Anaesthesiology and Intensive Care Medicine, Medical University of Graz, Auenbruggerplatz 5/5, 8036 Graz, Austria
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Seyedsadeghi M, Arabzadeh A, Entezariasl M, Shahbazzadegan B, Dindar S, Isazadehfar K. The Effect of Nicotine Patch on Reducing Nausea, Vomiting, and Pain Following Laparoscopic Cholecystectomy: A Randomized Clinical Trial. ADDICTION & HEALTH 2023; 15:39-44. [PMID: 37560080 PMCID: PMC10408744 DOI: 10.34172/ahj.2023.1364] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 09/12/2022] [Indexed: 08/11/2023]
Abstract
BACKGROUND The effect of nicotine on nausea, vomiting, and postoperative pain has been investigated in studies on animals and humans. This study aimed to evaluate the effect of nicotine patch on decreasing nausea, vomiting, and pain in laparoscopic cholecystectomy. METHODS The study sample consisted of 100 non-smoking patients undergoing laparoscopic cholecystectomy under general anesthesia in a triple-blind clinical trial. One hour after the start of surgery, patients were randomly assigned to receive 17.5-mg nicotine or placebo patches. The patches located on the right arm were left for 24 hours. The visual analogue scale (VAS) for pain and N/V score for the severity of nausea and vomiting were measured at intervals of 0, 6, 12, and 24 hours. FINDINGS The results showed there was no statistically significant difference between the groups in terms of pain intensity as well as nausea and vomiting at different time periods after surgery (P>0.05). A total of 36 patients in the nicotine group and 24 patients in the placebo group received meperidine. There was also no statistically significant difference between the two groups in terms of analgesics (P=0.096) and antiemetics (P=0.1). Moreover, the frequency of severe nausea and vomiting during the study in the nicotine group was higher than in the placebo group (4 vs. 1) but this difference was not statistically significant (P>0.05). CONCLUSION Receiving a 17.5-mg nicotine patch had a similar effect to receiving placebo in controlling postoperative pain, nausea, and vomiting in non-smokers. Nicotine use had no effect on reducing analgesia.
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Affiliation(s)
- Mirsalim Seyedsadeghi
- Department of Surgery, School of Medicine, Ardabil University of Medical Sciences, Ardebil, Iran
| | - Amirahmad Arabzadeh
- Department of Surgery, School of Medicine, Ardabil University of Medical Sciences, Ardebil, Iran
| | - Masood Entezariasl
- Department of Anesthesiology, School of Medicine, Ardabil University of Medical Sciences, Ardebil, Iran
| | - Bita Shahbazzadegan
- Social Determinants of Health Research Center, Department of Social Medicine, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Sajjad Dindar
- Department of Orthopedics, School of Medicine, Ardabil University of Medical Sciences, Ardebil, Iran
| | - Khatereh Isazadehfar
- Social Determinants of Health Research Center, Department of Social Medicine, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
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Geck MS, Lecca D, Marchese G, Casu L, Leonti M. Ethnomedicine and neuropsychopharmacology in Mesoamerica. JOURNAL OF ETHNOPHARMACOLOGY 2021; 278:114243. [PMID: 34129899 DOI: 10.1016/j.jep.2021.114243] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 04/27/2021] [Accepted: 05/24/2021] [Indexed: 06/12/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE The burden of disease caused by mental and neurological disorders is increasing globally, to a disproportionate degree in Latin America. In contrast to the many psychoactive plants with a use history in Mesoamerican cultures, the translation to the wider population of knowledge around numerous botanicals used contemporarily by indigenous Mesoamerican societies to treat psychological and neurological disorders did not receive the same attention. MATERIAL AND METHODS We used the previously published Mesoamerican Medicinal Plant Database to extract species and associated botanical drugs used as treatments for illnesses associated with the nervous system by Mesoamerican cultures in Belize, Guatemala, and Mexico. With the critical use of published pharmacological literature, the cross-culturally most salient genera are systematically reviewed. RESULTS From 2188 plant taxa contained in the database 1324 are used as treatments for illnesses associated with the nervous system. The ethnomedical data was critically confronted with the available biomedical literature for the 58 cross-culturally most salient genera. For a considerable proportion of the frequently used taxa, preclinical data are available, mostly validating ethnomedicinal uses. CONCLUSION This quantitative approach facilitates the prioritization of taxa for future pre-clinical, clinical and treatment outcome studies and gives patients, practitioners, and legislators a fundamental framework of evidence, on which to base decisions regarding phytomedicines.
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Affiliation(s)
- Matthias S Geck
- Department of Biomedical Sciences, University of Cagliari, Cittadella Universitaria, 09042, Monserrato, CA, Italy; Biovision - Foundation for Ecological Development, Heinrichstrasse 147, 8005, Zurich, Switzerland
| | - Daniele Lecca
- Department of Biomedical Sciences, University of Cagliari, Cittadella Universitaria, 09042, Monserrato, CA, Italy
| | - Giorgio Marchese
- Institute of Translational Pharmacology UOS of Cagliari National Research Council of Italy, Pula, Cagliari, Italy
| | - Laura Casu
- Department of Life and Environmental Sciences, University of Cagliari, Cittadella Universitaria, 09042, Monserrato, CA, Italy
| | - Marco Leonti
- Department of Biomedical Sciences, University of Cagliari, Cittadella Universitaria, 09042, Monserrato, CA, Italy.
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Association between Postoperative Opioid Requirements and the Duration of Smoking Cessation in Male Smokers after Laparoscopic Distal Gastrectomy with Gastroduodenostomy. Pain Res Manag 2021; 2021:1541748. [PMID: 33574973 PMCID: PMC7861925 DOI: 10.1155/2021/1541748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 12/23/2020] [Accepted: 01/15/2021] [Indexed: 11/18/2022]
Abstract
Smoking is clinically associated with high postoperative pain scores and increased perioperative analgesic requirements. However, the association between the duration of smoking cessation and postoperative opioid requirements remains unclear. Therefore, this study aimed to evaluate the association between the duration of smoking cessation and postoperative opioid requirements. We retrospectively analyzed the data of 144 male patients who received intravenous patient-controlled analgesia (IV PCA) after laparoscopic distal gastrectomy with gastroduodenostomy. All patients were divided into three groups: G0, nonsmoker; G1, smoker who quit smoking within 1 month preoperatively; G2, smoker who quit smoking over 1 month preoperatively. Analgesic use, pain intensity, and IV PCA side effects were assessed up to postoperative day 2. As the duration of smoking cessation increased, the amount of postoperative opioid consumption decreased (β = -0.08; 95% confidence interval (CI), -0.11 to -0.04; P < 0.001). The total postoperative opioid requirements in G1 were significantly higher than those in G0 and G2 (G0, 75.5 ± 15.9 mg; G1, 94.6 ± 20.5 mg; and G2, 79.9 ± 19.4 mg (P < 0.001)). A multivariate regression analysis revealed that G1 was independently associated with increased postoperative opioid requirements (β = 12.80; 95% CI, 5.81-19.80; P < 0.001). Consequently, male patients who had ceased smoking within 1 month of undergoing a laparoscopic distal gastrectomy with gastroduodenostomy had higher postoperative opioid use than patients who had ceased smoking for more than 1 month and nonsmokers.
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Effectiveness of nicotine patch for the control of pain, oedema, and trismus following third molar surgery: a randomized clinical trial. Int J Oral Maxillofac Surg 2020; 49:1508-1517. [DOI: 10.1016/j.ijom.2019.08.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 08/14/2019] [Accepted: 08/22/2019] [Indexed: 01/17/2023]
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Comparative study between transdermal nicotine and melatonin patches on postoperative pain relief after laparoscopic cholecystectomy, a double-blind, placebo-controlled trial. EGYPTIAN JOURNAL OF ANAESTHESIA 2019. [DOI: 10.1016/j.egja.2016.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Kyte SL, Gewirtz DA. The Influence of Nicotine on Lung Tumor Growth, Cancer Chemotherapy, and Chemotherapy-Induced Peripheral Neuropathy. J Pharmacol Exp Ther 2018; 366:303-313. [PMID: 29866790 PMCID: PMC6041956 DOI: 10.1124/jpet.118.249359] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 05/30/2018] [Indexed: 01/03/2023] Open
Abstract
Studies in animal models have suggested that nicotine, an agonist of nicotinic acetylcholine receptors, may have the potential to prevent and/or reverse the peripheral neuropathy induced by cancer chemotherapeutic drugs, such as paclitaxel and oxaliplatin. However, a large body of evidence suggests that nicotine may also stimulate lung tumor growth and/or interfere with the effectiveness of cancer chemotherapy. Whereas the reported proliferative effects of nicotine are highly variable, the antagonism of antitumor drug efficacy is more consistent, although this latter effect has been demonstrated primarily in cell culture studies. In contrast, in vitro and in vivo studies from our own laboratory indicate that nicotine fails to enhance the growth of nonsmall cell lung cancer cells or attenuate the effects of chemotherapy (paclitaxel). Given the inconsistencies in the literature, coupled with our own findings, the weight of evidence suggests that caution may be warranted in proposing to use nicotine to mitigate chemotherapy-induced peripheral neuropathy in cancer patients receiving chemotherapy. Conversely, clinical trials could be performed in patients who have completed therapy and are considered to be disease-free to determine whether nicotine, in the form of commercially available patches or gum, is effective in alleviating peripheral neuropathy symptoms.
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Affiliation(s)
- S Lauren Kyte
- Department of Pharmacology and Toxicology (S.L.K., D.A.G.) and Massey Cancer Center (D.A.G.), Virginia Commonwealth University, Richmond, Virginia
| | - David A Gewirtz
- Department of Pharmacology and Toxicology (S.L.K., D.A.G.) and Massey Cancer Center (D.A.G.), Virginia Commonwealth University, Richmond, Virginia
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MARTINS FILHO EUCLIDESDIAS, VASCONCELOS CÉSARFREIREDEMELO, OLIVEIRA FERNANDODESANTACRUZ, PEREIRA ADRIANODAFONSECA, FERRAZ ÁLVAROANTÔNIOBANDEIRA. Evaluation of nicotine patch in pain control of patients undergoing laparoscopic cholecystectomy. Rev Col Bras Cir 2018; 45:e1756. [DOI: 10.1590/0100-6991e-20181756] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 03/22/2018] [Indexed: 12/14/2022] Open
Abstract
ABSTRACT Objective: to analyze the effects of nicotine patch on pain control, occurrence of nausea and its hemodynamic repercussions in laparoscopic cholecystectomy procedures. Methods: we conducted an analytical, prospective, randomized, triple-blinded, clinical study between January and July 2017. The sample consisted of 17 patients who underwent laparoscopic cholecystectomy for the treatment of cholelithiasis. Nine patients used nicotine patch, and eight, placebo patch. The studied variables were pain, nausea, patient satisfaction, blood pressure, heart rate, oximetry and morphine rescue. Results: taking into account the pain and nausea parameters, there was no statistically significant difference between the groups (p>0.05). Also, the evaluation of rescue medication, both opioids and prokinetics, did not show any significant statistical difference between the groups. Among the hemodynamic parameters, there was only one statistically significant difference in the analysis of oxygen saturation and systolic blood pressure (SBP) six hours after surgery: the mean oxygen saturation was higher in the Test group (97.89 x 95.88) and the mean SBP was higher in the Control group (123.89 x 110.0). Conclusion: although pain levels were lower for nicotine within 24 hours, the action of nicotine and the need for rescue opioids in pain control were not statistically significant between the groups and at the time intervals studied. There was no clinical repercussion in the hemodynamic parameters.
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Kyte SL, Toma W, Bagdas D, Meade JA, Schurman LD, Lichtman AH, Chen ZJ, Del Fabbro E, Fang X, Bigbee JW, Damaj MI, Gewirtz DA. Nicotine Prevents and Reverses Paclitaxel-Induced Mechanical Allodynia in a Mouse Model of CIPN. J Pharmacol Exp Ther 2017; 364:110-119. [PMID: 29042416 DOI: 10.1124/jpet.117.243972] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 10/16/2017] [Indexed: 01/03/2023] Open
Abstract
Chemotherapy-induced peripheral neuropathy (CIPN), a consequence of peripheral nerve fiber dysfunction or degeneration, continues to be a dose-limiting and debilitating side effect during and/or after cancer chemotherapy. Paclitaxel, a taxane commonly used to treat breast, lung, and ovarian cancers, causes CIPN in 59-78% of cancer patients. Novel interventions are needed due to the current lack of effective CIPN treatments. Our studies were designed to investigate whether nicotine can prevent and/or reverse paclitaxel-induced peripheral neuropathy in a mouse model of CIPN, while ensuring that nicotine will not stimulate lung tumor cell proliferation or interfere with the antitumor properties of paclitaxel. Male C57BL/6J mice received paclitaxel every other day for a total of four injections (8 mg/kg, i.p.). Acute (0.3-0.9 mg/kg, i.p.) and chronic (24 mg/kg per day, s.c.) administration of nicotine respectively reversed and prevented paclitaxel-induced mechanical allodynia. Blockade of the antinociceptive effect of nicotine with mecamylamine and methyllycaconitine suggests that the reversal of paclitaxel-induced mechanical allodynia is primarily mediated by the α7 nicotinic acetylcholine receptor subtype. Chronic nicotine treatment also prevented paclitaxel-induced intraepidermal nerve fiber loss. Notably, nicotine neither promoted proliferation of A549 and H460 non-small cell lung cancer cells nor interfered with paclitaxel-induced antitumor effects, including apoptosis. Most importantly, chronic nicotine administration did not enhance Lewis lung carcinoma tumor growth in C57BL/6J mice. These data suggest that the nicotinic acetylcholine receptor-mediated pathways may be promising drug targets for the prevention and treatment of CIPN.
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Affiliation(s)
- S Lauren Kyte
- Departments of Pharmacology and Toxicology (S.L.K., W.T., D.B., J.A.M., L.D.S., A.H.L., M.I.D., D.A.G.), Neurology (Z.-J.C.), Internal Medicine (E.D.F.), Biochemistry and Molecular Biology (X.F.), and Anatomy and Neurobiology (J.W.B.), and Massey Cancer Center (D.A.G.), Virginia Commonwealth University, Richmond, Virginia; and Experimental Animals Breeding and Research Center, Uludag University, Bursa, Turkey (D.B.)
| | - Wisam Toma
- Departments of Pharmacology and Toxicology (S.L.K., W.T., D.B., J.A.M., L.D.S., A.H.L., M.I.D., D.A.G.), Neurology (Z.-J.C.), Internal Medicine (E.D.F.), Biochemistry and Molecular Biology (X.F.), and Anatomy and Neurobiology (J.W.B.), and Massey Cancer Center (D.A.G.), Virginia Commonwealth University, Richmond, Virginia; and Experimental Animals Breeding and Research Center, Uludag University, Bursa, Turkey (D.B.)
| | - Deniz Bagdas
- Departments of Pharmacology and Toxicology (S.L.K., W.T., D.B., J.A.M., L.D.S., A.H.L., M.I.D., D.A.G.), Neurology (Z.-J.C.), Internal Medicine (E.D.F.), Biochemistry and Molecular Biology (X.F.), and Anatomy and Neurobiology (J.W.B.), and Massey Cancer Center (D.A.G.), Virginia Commonwealth University, Richmond, Virginia; and Experimental Animals Breeding and Research Center, Uludag University, Bursa, Turkey (D.B.)
| | - Julie A Meade
- Departments of Pharmacology and Toxicology (S.L.K., W.T., D.B., J.A.M., L.D.S., A.H.L., M.I.D., D.A.G.), Neurology (Z.-J.C.), Internal Medicine (E.D.F.), Biochemistry and Molecular Biology (X.F.), and Anatomy and Neurobiology (J.W.B.), and Massey Cancer Center (D.A.G.), Virginia Commonwealth University, Richmond, Virginia; and Experimental Animals Breeding and Research Center, Uludag University, Bursa, Turkey (D.B.)
| | - Lesley D Schurman
- Departments of Pharmacology and Toxicology (S.L.K., W.T., D.B., J.A.M., L.D.S., A.H.L., M.I.D., D.A.G.), Neurology (Z.-J.C.), Internal Medicine (E.D.F.), Biochemistry and Molecular Biology (X.F.), and Anatomy and Neurobiology (J.W.B.), and Massey Cancer Center (D.A.G.), Virginia Commonwealth University, Richmond, Virginia; and Experimental Animals Breeding and Research Center, Uludag University, Bursa, Turkey (D.B.)
| | - Aron H Lichtman
- Departments of Pharmacology and Toxicology (S.L.K., W.T., D.B., J.A.M., L.D.S., A.H.L., M.I.D., D.A.G.), Neurology (Z.-J.C.), Internal Medicine (E.D.F.), Biochemistry and Molecular Biology (X.F.), and Anatomy and Neurobiology (J.W.B.), and Massey Cancer Center (D.A.G.), Virginia Commonwealth University, Richmond, Virginia; and Experimental Animals Breeding and Research Center, Uludag University, Bursa, Turkey (D.B.)
| | - Zhi-Jian Chen
- Departments of Pharmacology and Toxicology (S.L.K., W.T., D.B., J.A.M., L.D.S., A.H.L., M.I.D., D.A.G.), Neurology (Z.-J.C.), Internal Medicine (E.D.F.), Biochemistry and Molecular Biology (X.F.), and Anatomy and Neurobiology (J.W.B.), and Massey Cancer Center (D.A.G.), Virginia Commonwealth University, Richmond, Virginia; and Experimental Animals Breeding and Research Center, Uludag University, Bursa, Turkey (D.B.)
| | - Egidio Del Fabbro
- Departments of Pharmacology and Toxicology (S.L.K., W.T., D.B., J.A.M., L.D.S., A.H.L., M.I.D., D.A.G.), Neurology (Z.-J.C.), Internal Medicine (E.D.F.), Biochemistry and Molecular Biology (X.F.), and Anatomy and Neurobiology (J.W.B.), and Massey Cancer Center (D.A.G.), Virginia Commonwealth University, Richmond, Virginia; and Experimental Animals Breeding and Research Center, Uludag University, Bursa, Turkey (D.B.)
| | - Xianjun Fang
- Departments of Pharmacology and Toxicology (S.L.K., W.T., D.B., J.A.M., L.D.S., A.H.L., M.I.D., D.A.G.), Neurology (Z.-J.C.), Internal Medicine (E.D.F.), Biochemistry and Molecular Biology (X.F.), and Anatomy and Neurobiology (J.W.B.), and Massey Cancer Center (D.A.G.), Virginia Commonwealth University, Richmond, Virginia; and Experimental Animals Breeding and Research Center, Uludag University, Bursa, Turkey (D.B.)
| | - John W Bigbee
- Departments of Pharmacology and Toxicology (S.L.K., W.T., D.B., J.A.M., L.D.S., A.H.L., M.I.D., D.A.G.), Neurology (Z.-J.C.), Internal Medicine (E.D.F.), Biochemistry and Molecular Biology (X.F.), and Anatomy and Neurobiology (J.W.B.), and Massey Cancer Center (D.A.G.), Virginia Commonwealth University, Richmond, Virginia; and Experimental Animals Breeding and Research Center, Uludag University, Bursa, Turkey (D.B.)
| | - M Imad Damaj
- Departments of Pharmacology and Toxicology (S.L.K., W.T., D.B., J.A.M., L.D.S., A.H.L., M.I.D., D.A.G.), Neurology (Z.-J.C.), Internal Medicine (E.D.F.), Biochemistry and Molecular Biology (X.F.), and Anatomy and Neurobiology (J.W.B.), and Massey Cancer Center (D.A.G.), Virginia Commonwealth University, Richmond, Virginia; and Experimental Animals Breeding and Research Center, Uludag University, Bursa, Turkey (D.B.)
| | - David A Gewirtz
- Departments of Pharmacology and Toxicology (S.L.K., W.T., D.B., J.A.M., L.D.S., A.H.L., M.I.D., D.A.G.), Neurology (Z.-J.C.), Internal Medicine (E.D.F.), Biochemistry and Molecular Biology (X.F.), and Anatomy and Neurobiology (J.W.B.), and Massey Cancer Center (D.A.G.), Virginia Commonwealth University, Richmond, Virginia; and Experimental Animals Breeding and Research Center, Uludag University, Bursa, Turkey (D.B.)
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Smoking May Increase Postoperative Opioid Consumption in Patients Who Underwent Distal Gastrectomy With Gastroduodenostomy for Early Stomach Cancer. Clin J Pain 2017; 33:905-911. [DOI: 10.1097/ajp.0000000000000472] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Lambrichts DPV, Boersema GSA, Tas B, Wu Z, Vrijland WW, Kleinrensink GJ, Jeekel J, Lange JF, Menon AG. Nicotine chewing gum for the prevention of postoperative ileus after colorectal surgery: a multicenter, double-blind, randomised, controlled pilot study. Int J Colorectal Dis 2017; 32:1267-1275. [PMID: 28660314 PMCID: PMC5554272 DOI: 10.1007/s00384-017-2839-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/12/2017] [Indexed: 02/04/2023]
Abstract
PURPOSE When postoperative ileus is not resolved after 5 days or recurs after resolution, prolonged POI (PPOI) is diagnosed. PPOI increases discomfort, morbidity and hospitalisation length, and is mainly caused by an inflammatory response following intestinal manipulation. This response can be weakened by targeting the cholinergic anti-inflammatory pathway, with nicotine as essential regulator. Chewing gum, already known to stimulate gastrointestinal motility itself, combined with nicotine is hypothesised to improve gastrointestinal recovery and prevent PPOI. This pilot study is the first to assess efficacy and safety of nicotine gum in colorectal surgery. METHODS Patients undergoing elective oncological colorectal surgery were enrolled in this double-blind, parallel-group, controlled trial and randomly assigned to a treatment protocol with normal or nicotine gum (2 mg). Patient reported outcomes (PROMS), clinical characteristics and blood samples were collected. Primary endpoint was defined as time to first passage of faeces and toleration of solid food for at least 24 h. RESULTS In total, 40 patients were enrolled (20 vs. 20). In both groups, six patients developed PPOI. Time to primary endpoint (4.50 [3.00-7.25] vs. 3.50 days [3.00-4.25], p = 0.398) and length of stay (5.50 [4.00-8.50] vs. 4.50 days [4.00-6.00], p = 0.738) did not differ significantly between normal and nicotine gum. There were no differences in PROMS, inflammatory parameters and postoperative complications. CONCLUSIONS We proved nicotine gum to be safe but ineffective in improving gastrointestinal recovery and prevention of PPOI after colorectal surgery. Other dosages and administration routes of nicotine should be tested in future research.
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Affiliation(s)
- Daniël P. V. Lambrichts
- 000000040459992Xgrid.5645.2Department of Surgery, Erasmus University Medical Center, Room H822k, PO BOX 2040, 3000 CA Rotterdam, The Netherlands
| | - Geesien S. A. Boersema
- 000000040459992Xgrid.5645.2Department of Surgery, Erasmus University Medical Center, Room H822k, PO BOX 2040, 3000 CA Rotterdam, The Netherlands
| | - Buket Tas
- 000000040459992Xgrid.5645.2Department of Surgery, Erasmus University Medical Center, Room H822k, PO BOX 2040, 3000 CA Rotterdam, The Netherlands
| | - Zhouqiao Wu
- 0000 0001 0027 0586grid.412474.0Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education, Beijing), Ward I of Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, Beijing, China
| | - Wietske W. Vrijland
- Department of Surgery, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - Gert-Jan Kleinrensink
- 000000040459992Xgrid.5645.2Department of Neuroscience, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Johannes Jeekel
- 000000040459992Xgrid.5645.2Department of Neuroscience, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Johan F. Lange
- 000000040459992Xgrid.5645.2Department of Surgery, Erasmus University Medical Center, Room H822k, PO BOX 2040, 3000 CA Rotterdam, The Netherlands ,0000 0004 0460 0097grid.477310.6Department of Surgery, Havenziekenhuis, Rotterdam, The Netherlands
| | - Anand G. Menon
- 000000040459992Xgrid.5645.2Department of Surgery, Erasmus University Medical Center, Room H822k, PO BOX 2040, 3000 CA Rotterdam, The Netherlands ,0000 0004 0460 0097grid.477310.6Department of Surgery, Havenziekenhuis, Rotterdam, The Netherlands
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Matthews AM, Fu R, Dana T, Chou R. Intranasal or transdermal nicotine for the treatment of postoperative pain. Cochrane Database Syst Rev 2016; 2016:CD009634. [PMID: 26756459 PMCID: PMC8729826 DOI: 10.1002/14651858.cd009634.pub2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Acute pain frequently occurs after surgical procedures. Nicotine has been explored as an adjunctive medication for management of postoperative pain. OBJECTIVES To assess the effect of transdermal or intranasal nicotine administration on postoperative pain, opioid analgesic use, and opioid-related adverse events. SEARCH METHODS We searched MEDLINE (1966 to 20 March 2014), the Cochrane Central Register of Controlled Trials (CENTRAL; 2014, Issue 3), EMBASE (1980 to 20 March 2014), and also databases of ongoing trials (www.controlled-trials.com/ and http://clinicaltrials.gov/). We re-ran the search on 28 April 2015. We will assess the one study of interest when we update the review. SELECTION CRITERIA We included 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. We excluded all other studies. DATA COLLECTION AND ANALYSIS Two authors independently screened all titles and abstracts for eligibility and documented reasons for exclusion. In case of disagreement, a third author decided on the inclusion or exclusion of a trial report. When additional information was needed in order to decide if a trial should be included, one of the authors contacted the corresponding author of the trial in question. MAIN RESULTS Nine trials (666 participants) evaluated nicotine for postoperative pain. Nicotine may reduce postoperative pain scores at 24 hours by a small amount compared with placebo (eight trials, mean difference -0.88 on a 0 to 10 scale, 95% confidence interval (CI) -1.58 to -0.18; low quality evidence). The effect on pain at one hour and 12 hours postoperatively was less certain (very low quality evidence). Statistical heterogeneity was substantial and not adequately explained by stratification of trials according to type of surgical procedure, smoking status, mode of nicotine administration, timing of administration, or assessed risk of bias. Excluding one trial at high risk of bias resulted in similar findings. The effect of nicotine on postoperative opioid use was uncertain due to small number of participants in the studies. Nicotine probably increases the risk of postoperative nausea (seven trials, RR 1.24, 95% CI 1.03 to 1.50; moderate quality evidence). Three trials assessed sedation but the effect is very uncertain due to the very low quality of evidence. We found no evidence that nicotine increased the risk of vomiting (seven studies, risk difference (RD) 0.03, 95% CI -0.04 to 0.09; low quality evidence). The results from one single small trial were insufficient to establish whether nicotine led to an earlier hospital discharge (very low quality evidence). AUTHORS' CONCLUSIONS 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. 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.
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Affiliation(s)
- Annette M Matthews
- Portland VA Medical CenterDepartment of Behavioral Health and Neurosciences3710 SW US Veterans Hospital RoadPortlandOregonUSA97207
- Oregon Health & Science UniversityDepartment of PsychiatryPortlandOregonUSA
- Oregon Health & Science UniversityDepartment of Medical Informatics & Clinical EpidemiologyPortlandOregonUSA
| | - Rongwei Fu
- Oregon Health & Science UniversityDepartments of Public Health and Preventive Medicine and Emergency Medicine3181 SW Sam Jackson Park Rd, Mail Code: #CB669PortlandOregonUSA97239
| | - Tracy Dana
- Oregon Health & Science UniversityDepartment of Medical Informatics & Clinical EpidemiologyPortlandOregonUSA
| | - Roger Chou
- Oregon Health & Science UniversityDepartment of Medical Informatics & Clinical EpidemiologyPortlandOregonUSA
- Oregon Health & Science UniversityDepartment of Internal MedicinePortlandOregonUSA
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Joshi GP, Jaschinski T, Bonnet F, Kehlet H. Optimal pain management for radical prostatectomy surgery: what is the evidence? BMC Anesthesiol 2015; 15:159. [PMID: 26530113 PMCID: PMC4632348 DOI: 10.1186/s12871-015-0137-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 10/22/2015] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Increase in the diagnosis of prostate cancer has increased the incidence of radical prostatectomy. However, the literature assessing pain therapy for this procedure has not been systematically evaluated. Thus, optimal pain therapy for patients undergoing radical prostatectomy remains controversial. METHODS Medline, Embase, and Cochrane Central Register of Controlled Trials were searched for studies assessing the effects of analgesic and anesthetic interventions on pain after radical prostatectomy. All searches were conducted in October 2012 and updated in June 2015. RESULTS Most treatments studied improved pain relief and/or reduced opioid requirements. However, there were significant differences in the study designs and the variables evaluated, precluding quantitative analysis and consensus recommendations. CONCLUSIONS This systematic review reveals that there is a lack of evidence to develop an optimal pain management protocol in patients undergoing radical prostatectomy. Most studies assessed unimodal analgesic approaches rather than a multimodal technique. There is a need for more procedure-specific studies comparing pain and analgesic requirements for open and minimally invasive surgical procedures. Finally, while we wait for appropriate procedure specific evidence from publication of adequate studies assessing optimal pain management after radical prostatectomy, we propose a basic analgesic guideline.
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Affiliation(s)
- Grish P Joshi
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical School, 5323 Harry Hines Blvd, Dallas, TX, 75390-9068, USA.
| | - Thomas Jaschinski
- Institute for Research in Operative Medicine, Witten/Herdecke University, Cologne, Germany
| | - Francis Bonnet
- Department d' Anesthesie Reanimation, Hôpital Tenon, Assistance Publique Hôpitaux de Paris Université Pierre & Marie Curie, Paris, France
| | - Henrik Kehlet
- Section for Surgical Pathophysiology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
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Intranasal Nicotine Increases Postoperative Nausea and is Ineffective in Reducing Pain Following Laparoscopic Bariatric Surgery in Tobacco-Naïve Females: A Randomized, Double Blind Trial. Obes Surg 2014; 25:506-13. [DOI: 10.1007/s11695-014-1431-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Parkerson HA, Zvolensky MJ, Asmundson GJG. Understanding the relationship between smoking and pain. Expert Rev Neurother 2014; 13:1407-14. [PMID: 24236905 DOI: 10.1586/14737175.2013.859524] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This review provides an overview of evidence regarding several key mechanisms pertinent to understanding the co-occurrence of smoking dependence and pain, both potentially costly conditions, and highlights treatment implications and future research directions. We describe each of pain and smoking dependence and introduce a revised integrative reciprocal model that explains their co-occurrence. We then provide a selective review of evidence pertinent to direct and indirect pathways between variables postulated in the model. We also provide general recommendations for improving assessment and treatment of smokers with clinically significant pain. We conclude with a targeted agenda for future investigation of the co-occurrence of smoking and pain. Empirical efforts directed at testing postulates of the proposed integrative model may yield a better understanding of the nature of the relationship between these prevalent and costly health conditions as well as evidence-based preventive and treatment strategies for people who experience nicotine dependence and pain-related disability.
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Affiliation(s)
- Holly A Parkerson
- Department of Psychology, University of Regina, Regina, Saskatchewan, Canada S4S 0A2
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Wu Z, Boersema GSA, Jeekel J, Lange JF. Nicotine gum chewing: a novel strategy to shorten duration of postoperative ileus via vagus nerve activation. Med Hypotheses 2014; 83:352-4. [PMID: 24998667 DOI: 10.1016/j.mehy.2014.06.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 05/12/2014] [Accepted: 06/09/2014] [Indexed: 11/19/2022]
Abstract
Postoperative ileus (POI) is a transit cessation of bowel motility after surgery. Substantial evidences suggest that gum chewing accelerate the recovery of bowel motility after surgery. Perioperative nicotine administration reduces postoperative opioid use and prevents postoperative nausea and vomiting. Nicotine gum chewing combines stimulation of the cephalic-vagal reflex by gum chewing, and activation of the cholinergic anti-inflammatory pathway by nicotine administration. We therefore hypothesized that nicotine gum chewing reduces POI and improves patient outcomes such as shortening the length of hospitalization as well as saving medical costs. As nicotine gum is commercially available, inexpensive, and has been in use for many years without any severe side effects, it may have a wide clinical application in POI prevention.
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Affiliation(s)
- Z Wu
- Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | - G S A Boersema
- Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - J Jeekel
- Department of Neuroscience, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - J F Lange
- Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
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Abstract
The present guidelines are the most recent data on postoperative nausea and vomiting (PONV) and an update on the 2 previous sets of guidelines published in 2003 and 2007. These guidelines were compiled by a multidisciplinary international panel of individuals with interest and expertise in PONV under the auspices of the Society for Ambulatory Anesthesia. The panel members critically and systematically evaluated the current medical literature on PONV to provide an evidence-based reference tool for the management of adults and children who are undergoing surgery and are at increased risk for PONV. These guidelines identify patients at risk for PONV in adults and children; recommend approaches for reducing baseline risks for PONV; identify the most effective antiemetic single therapy and combination therapy regimens for PONV prophylaxis, including nonpharmacologic approaches; recommend strategies for treatment of PONV when it occurs; provide an algorithm for the management of individuals at increased risk for PONV as well as steps to ensure PONV prevention and treatment are implemented in the clinical setting.
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Di Cesare Mannelli L, Zanardelli M, Ghelardini C. Nicotine is a pain reliever in trauma- and chemotherapy-induced neuropathy models. Eur J Pharmacol 2013; 711:87-94. [DOI: 10.1016/j.ejphar.2013.04.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Revised: 04/15/2013] [Accepted: 04/18/2013] [Indexed: 01/03/2023]
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Sidhu N, Davies S, Nadarajah A, Rivera J, Whittington R, Mercier RJ, Virag L, Wang S, Flood P. Oral choline supplementation for postoperative pain. Br J Anaesth 2013; 111:249-55. [PMID: 23568851 DOI: 10.1093/bja/aet031] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Activation of nicotinic receptors with nicotine has been shown to reduce post-surgical pain in clinical and preclinical studies. Choline is a selective agonist at α7-type nicotinic receptors that does not have addictive or sympathetic activating properties. It is anti-nociceptive in animal studies. We conducted a double-blind randomized trial of oral choline supplementation with lecithin to aid in the treatment of pain after gynaecological surgery. METHODS Sixty women having open gynaecological surgery were randomly assigned to receive 20 g of lecithin before surgery or placebo. Plasma choline concentration and tumour necrosis factor (TNF) were measured. Pain report was the primary outcome measure. RESULTS We achieved a small but statistically significant increase in choline after surgery with oral supplementation. Plasma TNF was not decreased and pain report was not different between groups at rest or with movement. There were no adverse effects of treatment. CONCLUSIONS Oral supplementation with lecithin during the perioperative period resulted in very slow absorption and thus only a small increase in plasma choline was achieved. This concentration was inadequate to reduce TNF as has been shown in other studies. The absence of an anti-inflammatory effect was likely related to our failure to demonstrate efficacy in pain reduction.
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Affiliation(s)
- N Sidhu
- University of California, San Francisco, San Francisco, CA, USA
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Talka R, Salminen O, Whiteaker P, Lukas RJ, Tuominen RK. Nicotine–morphine interactions at α4β2, α7 and α3⁎ nicotinic acetylcholine receptors. Eur J Pharmacol 2013; 701:57-64. [DOI: 10.1016/j.ejphar.2013.01.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Revised: 12/19/2012] [Accepted: 01/09/2013] [Indexed: 12/12/2022]
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Effects of Nicotine on Spinal Cord Injury Pain Vary Among Subtypes of Pain and Smoking Status: Results From a Randomized, Controlled Experiment. THE JOURNAL OF PAIN 2012; 13:1206-14. [DOI: 10.1016/j.jpain.2012.09.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Revised: 08/24/2012] [Accepted: 09/17/2012] [Indexed: 01/11/2023]
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Matthews AM, Fu R, Dana T, Chou R. Intranasal or transdermal nicotine for the treatment of postoperative pain. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2012. [DOI: 10.1002/14651858.cd009634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Sanders AE, Maixner W, Nackley AG, Diatchenko L, By K, Miller VE, Slade GD. Excess risk of temporomandibular disorder associated with cigarette smoking in young adults. THE JOURNAL OF PAIN 2012; 13:21-31. [PMID: 22036516 PMCID: PMC3249502 DOI: 10.1016/j.jpain.2011.08.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Revised: 06/23/2011] [Accepted: 08/01/2011] [Indexed: 12/19/2022]
Abstract
UNLABELLED Evidence suggests that the effect of cigarette smoking on chronic pain is stronger in younger than older adults. This case-control study investigated whether age modified an effect of smoking on temporomandibular disorder (TMD) in 299 females aged 18 to 60 years. It also investigated the extent to which this relationship was explained by psychological profile, inflammatory response, and allergy. Cases were defined using the Research Diagnostic Criteria for Temporomandibular Disorders based on clinical examination. Psychological profile was evaluated using standardized instruments. Inflammatory response was evaluated with 11 cytokines isolated in plasma. History of allergy conditions was self-reported. Odds ratios (ORs) for the effect of smoking were calculated using binary logistic regression. Stratified analyses and the likelihood ratio test examined effect modification by smoking. Compared with nonsmokers, ever smokers aged <30 years had higher odds of TMD (OR = 4.14, 95% CI: 1.57, 11.35) than older adults (OR = 1.23, 95% CI: .55, 2.78) (P (effect modification) = .038). Adjustment for psychological profile, cytokines, and history of allergy-like conditions attenuated the effect by 45% to statistical nonsignificance. The main finding was reproduced with secondary analyses of 2 nationally representative surveys of adults conducted in the US and Australia. PERSPECTIVE This study showed that smoking was associated with TMD risk in females, but only in young adulthood. It replicated this finding in 2 nationally representative surveys of females in the US and Australia. Findings may alert clinicians to recognize that smoking is a concern for TMD in younger female patients.
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Affiliation(s)
- Anne E Sanders
- Department of Dental Ecology, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7450, USA.
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Randomised trial of intranasal nicotine and postoperative pain, nausea and vomiting in non-smoking women. Eur J Anaesthesiol 2011; 28:585-91. [PMID: 21562425 DOI: 10.1097/eja.0b013e328344d998] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The primary aim of this study is to test the hypothesis that intranasal nicotine reduces postoperative opioid use among non-smoking women. The second aim is to determine the effects of intranasal nicotine on the incidence of postoperative nausea and vomiting (PONV). METHODS In this double-blind, randomised placebo-controlled trial, non-smoking women undergoing gynaecological procedures received either 3 mg intranasal nicotine (N=90) or placebo spray (N=89) at the conclusion of surgery. Postoperative opioid use (intravenous morphine equivalents) and PONV rates were recorded during the recovery room (postanaesthesia care unit, PACU) stay and first 24 postoperative hours. RESULTS From an overall analysis, opioid dose administered within the first 24 h was lower in patients receiving nicotine [median (25th, 75th) 38 (17, 62) mg for placebo vs. 25 (13, 46) mg for nicotine; P=0.012]. Inpatients who received intranasal nicotine used less opioid. From an overall analysis, patients in the nicotine group were more likely to experience nausea (71.1 vs. 56.2% P=0.044), receive rescue antiemetics (57.8 vs. 38.2% P=0.011), and report higher Nausea Verbal Descriptive Scores [2 (0, 2; vs. 1 (0, 2), P=0.006] in PACU. Inpatients who received nicotine were more likely to receive antiemetics (P=0.009) and report higher Nausea Verbal Descriptive Scores (P=0.025) in the PACU. CONCLUSION Intraoperative use of intranasal nicotine has a sustained opioid-sparing effect in non-smoking women undergoing gynaecological procedures and is associated with a higher frequency of PONV.
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A randomised double-blind crossover trial of the potential analgesic effect of a transdermal nicotine patch in non-smokers based on objective and subjective assessment. Eur J Anaesthesiol 2011; 28:592-6. [PMID: 21681103 DOI: 10.1097/eja.0b013e328347dfd4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The results of studies of the analgesic effect of nicotine in humans are complex because these studies have included smokers with variable smoking histories. We investigated whether the use of a 17.5 mg transdermal nicotine (TDN) patch decreased the magnitude of pressure pain on the hands of healthy non-smoking volunteers. DESIGN This was a randomised double-blind crossover trial. A TDN patch or placebo (drug-free bandage) was applied randomly on the anterior chest of non-smoking volunteers 1 h before the experiments. We measured minimum perceived current and pain threshold on the right hand and then evaluated the magnitude of pressure pain by using the Pain Vision PS-2100 (Nipro Co., Osaka, Japan) which helps in objective quantitative assessment of pain magnitude. After estimating minimum perceived current, pressure pain was produced using a combination of 100-g discs and a rod. The rod and the discs weighing 0 (no disc), 200 (two discs), 400 (four discs), 200 (two discs) and 0 g (no disc) were placed consecutively in this order on the right hand and pain threshold was measured. At the same time, volunteers were asked to rate pain on a numerical rating scale (NRS). Minimum perceived current is the current at which the volunteer perceives the first sensation on applying gradually increasing pulsed current. Pain threshold is the compatible electrode current at which the volunteer feels the intensity of pressure pain. Pain degree is calculated as (pain threshold-minimum perceived current)/minimum perceived current × 100. PARTICIPANTS Forty non-smoking volunteers were enrolled in this study. RESULTS No significant differences between groups were observed in minimum perceived current, pain threshold, pain degree or NRS. Of the volunteers who received the nicotine patch, four became anorexic and nauseated and two required anti-emetics. CONCLUSION The nicotine patch had no analgesic effect in non-smoking volunteers.
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Czarnetzki C, Schiffer E, Lysakowski C, Haller G, Bertrand D, Tramèr MR. Transcutaneous nicotine does not prevent postoperative nausea and vomiting: a randomized controlled trial. Br J Clin Pharmacol 2011; 71:383-90. [PMID: 21284697 DOI: 10.1111/j.1365-2125.2010.03844.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
AIMS There is empirical evidence that smokers are less likely to suffer from postoperative nausea and vomiting (PONV). We sought to investigate whether transcutaneus nicotine prevents PONV. METHODS Non-smokers receiving general anaesthesia for surgery were randomly allocated to Nicotinell Patch 10cm(2) (TTS 10), containing 17.5mg of nicotine (average delivery rate, 7mg 24h(-1) ) or matching placebo patch. Patches were applied 1h before surgery and were left in situ until 24h after surgery (or until the first PONV symptoms occurred). RESULTS We randomized 90 patients (45 nicotine, 45 placebo). In the post-anaesthetic care unit, the incidence of nausea was 22.2% with nicotine and 24.4% with placebo (P= 0.80), and the incidence of vomiting was 20.0% with nicotine and 17.8% with placebo (P= 0.78). Cumulative 24h incidence of nausea was 42.2% with nicotine and 40.0% with placebo (P= 0.83), and of vomiting was 31.1% with nicotine and 28.9% with placebo (P= 0.81). PONV episodes tended to occur earlier in the nicotine group. Postoperative headache occurred in 17.8% of patients treated with nicotine and in 15.6% with placebo (P= 0.49). More patients receiving nicotine reported a low quality of sleep during the first postoperative night (26.7% vs. 6.8% with placebo; P= 0.01). CONCLUSIONS Non-smokers receiving a prophylactic nicotine patch had a similar incidence of PONV during the first 24h and tended to develop PONV symptoms earlier compared with controls. They had a significantly increased risk of insomnia during the first postoperative night.
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Affiliation(s)
- Christoph Czarnetzki
- Division of Anaesthesiology Clinical Trial Unit, University Hospitals of Geneva, Geneva, Switzerland Department of Neurosciences Medical Faculty, University of Geneva, Geneva, Switzerland.
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Yagoubian B, Akkara J, Afzali P, Alfi DM, Olson L, Conell-Price J, Yeh J, Eisig SB, Flood P. Nicotine nasal spray as an adjuvant analgesic for third molar surgery. J Oral Maxillofac Surg 2011; 69:1316-9. [PMID: 21256649 DOI: 10.1016/j.joms.2010.07.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2010] [Revised: 06/16/2010] [Accepted: 07/03/2010] [Indexed: 10/18/2022]
Abstract
PURPOSE To determine the efficacy of preoperatively administered nicotine nasal spray (3 mg) for analgesia after third molar (TM) surgery. MATERIALS AND METHODS A single-center, prospective, randomized, double-blind, crossover trial was conducted. The study population consisted of 20 nonsmoking patients referred to the Department of Oral and Maxillofacial Surgery of Columbia University College of Dental Medicine for extraction of all 4 TMs. Each patient received nicotine nasal spray or placebo spray before TM surgery. At a subsequent visit the contralateral TMs were removed with prior administration of the alternate treatment. For an hour postoperatively, subjects reported information on pain and nausea, and hemodynamic variables were recorded at 15-minute intervals. Telephone follow-up was recorded for 5 days postoperatively, where patients reported information on pain, nausea, and use of hydrocodone/acetaminophen as rescue analgesia. RESULTS Nicotine treatment was associated with a highly significant decrease in pain reported during the 5 days after TM surgery. There was no difference in the amount of hydrocodone/acetaminophen used or amount of nausea reported. There was a small but significant increase in heart rate after nicotine treatment compared with placebo during the first hour after surgery. There was no difference in blood pressure between groups. CONCLUSION Pain is well controlled by hydrocodone/acetaminophen in most patients after TM surgery. However, there is significant variability in pain reported. Nicotinic agonists represent a new class of analgesic that can be considered for patients who are expected to have significant opioid-resistant pain after TM surgery. Caution should be used with patients in whom a small increase in heart rate would be deleterious.
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Affiliation(s)
- Benjamin Yagoubian
- Department of Oral and Maxillofacial Surgery, College of Dental Medicine, Columbia University, New York, NY 10032, USA.
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Skurtveit S, Furu K, Selmer R, Handal M, Tverdal A. Nicotine dependence predicts repeated use of prescribed opioids. Prospective population-based cohort study. Ann Epidemiol 2010; 20:890-7. [PMID: 20627770 DOI: 10.1016/j.annepidem.2010.03.010] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2009] [Revised: 02/11/2010] [Accepted: 03/03/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE The aim of this study was to evaluate prospectively smoking dependence as a predictor of repeated use of prescribed opioids in non-cancer patients. METHODS We conducted a prospective population-based study cohort of 12,848 men and 15,894 women 30-75 years of age in health surveys in Norway during 2000-2002 with repeated opioid prescriptions (12+, during 2004-2007) recorded in the Norwegian Prescription Database as the outcome measure. Information on history of smoking and potential confounders was obtained at baseline by self-administered questionnaires. For smoking, participants were divided into categories: never; previously heavy (stopped maximum of 5 years earlier; 10+ cigarettes daily); daily not heavy (1-9 cigarettes); dependent daily smokers (10+ cigarettes), and other (previously and/or not daily). Odds ratios (ORs) with 95% confidence intervals (CIs) were estimated by logistic regression. RESULTS During follow-up, 335 (1.5%) of survey participants were registered with 12+ prescriptions of opioids during the period 2004-2007. The prevalence of repeated prescription frequency of opioids was higher for men and women with a history of smoking. The adjusted OR for prescribed opioids for dependent daily smokers was 3.1 (95% CI: 2.3-4.1), for daily non-heavy smokers 1.8 (1.2-2.7), and for previous heavy smokers 1.8 (1.1-3.0), compared with never-smokers as reference. CONCLUSIONS Results of the study suggest that smoking dependence may predict more frequent use of opioids.
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Affiliation(s)
- Svetlana Skurtveit
- Department of Pharmacoepidemiology, Norwegian Institute of Public Health, and Norwegian Centre for Addiction Research, University of Oslo, Norway.
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Rowley TJ, McKinstry A, Greenidge E, Smith W, Flood P. Antinociceptive and anti-inflammatory effects of choline in a mouse model of postoperative pain. Br J Anaesth 2010; 105:201-7. [PMID: 20511332 DOI: 10.1093/bja/aeq113] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Choline is a dietary supplement that activates alpha7 nicotinic receptors. alpha7 nicotinic activation reduces cytokine production by macrophages and has antinociceptive activity in inflammatory pain models. We hypothesized that systemic administration of choline would reduce the inflammatory response from macrophages and have antinociceptive efficacy in a murine model of postoperative pain. METHODS We studied the response of wild-type and alpha7 nicotinic knockout mice to heat and punctate pressure after a model surgical procedure. We investigated the effect of genotype and choline treatment on alpha-bungarotoxin binding to, and their production of tumour necrosis factor (TNF) from, macrophages. RESULTS Choline provided moderate antinociception. The ED(50) for choline inhibition of heat-induced allodynia was 1.7 mg kg(-1) h(-1). The ED(50) for punctate pressure threshold was 4.7 mg kg(-1) h(-1) choline. alpha7 nicotinic knockout mice had no change in hypersensitivity to heat or pressure and were significantly different from littermate controls when treated with choline 5 mg kg(-1) h(-1) (P<0.05, 0.01). Choline 100 mM reduced binding of alpha-bungarotoxin to macrophages by 72% and decreased their release of TNF by up to 51 (sd 11)%. There was no difference by genotype in the inhibition of TNF release by choline. CONCLUSIONS Systemic choline is a moderately effective analgesic via activation of alpha7 nicotinic acetylcholine receptors. The antinocicepive effect may not be mediated by a reduction of TNF pathway cytokine release from macrophages. Although choline at millimolar concentrations clearly inhibits the release of TNF, this effect is not alpha7 subunit-dependent and occurs at concentrations likely higher than reached systemically in vivo.
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Affiliation(s)
- T J Rowley
- Department of Anesthesiology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
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Gao B, Hierl M, Clarkin K, Juan T, Nguyen H, van der Valk M, Deng H, Guo W, Lehto SG, Matson D, McDermott JS, Knop J, Gaida K, Cao L, Waldon D, Albrecht BK, Boezio AA, Copeland KW, Harmange JC, Springer SK, Malmberg AB, McDonough SI. Pharmacological effects of nonselective and subtype-selective nicotinic acetylcholine receptor agonists in animal models of persistent pain. Pain 2010; 149:33-49. [DOI: 10.1016/j.pain.2010.01.007] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2009] [Revised: 12/16/2009] [Accepted: 01/11/2010] [Indexed: 12/20/2022]
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Brattwall M, Warrén Stomberg M, Rawal N, Segerdahl M, Houltz E, Jakobsson J. Postoperative impact of regular tobacco use, smoking or snuffing, a prospective multi-center study. Acta Anaesthesiol Scand 2010; 54:321-7. [PMID: 19860750 DOI: 10.1111/j.1399-6576.2009.02140.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The aim was to study the effects of different tobacco administration routes on pain and post-operative nausea and vomiting (PONV), following three common day surgical procedures: cosmetic breast augmentation (CBA), inguinal hernia repair (IHR) and arthroscopic procedures (AS). We have prospectively investigated the effects of regular tobacco use in ambulatory surgery. METHODS The 355 allocated patients were followed during recovery and the first day at home. RESULTS Thirty-two percent of the patients used tobacco regularly, 33% of CBA, 27% of IHR and 34% of AS. Pain was well controlled in the post-anesthesia care unit at rest; during ambulation, 37% of all patients reported VAS>3. Tobacco use had no impact on early post-operative pain. Post-operative nausea was experienced by 30% of patients during recovery while in hospital. On day 1, 14% experienced nausea. We found a significant reduction of PONV among tobacco users (smoking and/or snuffing). Smoking or snuffing reduced the risk of PONV by nearly 50% in both genders on the day of surgery and at the first day at home. The reduction of PONV was equal, regardless of tobacco administration routes. CONCLUSION We found that regular use of tobacco, both by smoking and snuffing, had a significant effect on PONV during the early post-operative period. Non-tobacco users undergoing breast surgery were found to have the highest risk for PONV. We could not see any influence of nicotine use on post-operative pain. Thus, it seems of value to identify regular tobacco use, not only smoking, as a part of the pre-operative risk assessment.
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Affiliation(s)
- M Brattwall
- Department of Anaesthesia, Institute for Clinical Sciences, Sahlgrenska University Hospital/Mölndal, Göteborg, Sweden.
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Olson LC, Hong D, Conell-Price JS, Cheng S, Flood P. A transdermal nicotine patch is not effective for postoperative pain management in smokers: a pilot dose-ranging study. Anesth Analg 2009; 109:1987-91. [PMID: 19923530 DOI: 10.1213/ane.0b013e3181bd1612] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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. CONCLUSIONS Transdermal nicotine, 5-15 mg, failed to relieve postoperative pain or reduce opioid use in smokers.
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Affiliation(s)
- Luke C Olson
- Department of Anesthesiology, Columbia University Medical Center, New York, New York, USA
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Holtman JR, Crooks PA, Johnson-Hardy JK, Wala EP. The analgesic and toxic effects of nornicotine enantiomers alone and in interaction with morphine in rodent models of acute and persistent pain. Pharmacol Biochem Behav 2009; 94:352-62. [PMID: 19800911 DOI: 10.1016/j.pbb.2009.09.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2009] [Revised: 09/01/2009] [Accepted: 09/24/2009] [Indexed: 11/25/2022]
Abstract
Neuronal nicotinic acetylcholinic receptors (nAChR) are promising targets for the development of novel analgesics. Nicotine and other nAChR-agonists produce profound analgesia in rodent models of acute and persistent pain. However, significant side-effects are of concern. Nornicotine (N-desmethyl-nicotine) appears to activate different nAChR subtypes, has a better pharmacokinetic profile, and produces less toxicity than nicotine. Little is known about its analgesic properties. In the present study, the S(-)- and R(+)-enantiomers of nornicotine were characterized with regard to analgesia and side-effects profile. Efficacy was demonstrated in rat models of pain where central sensitization is involved: i.e. the chronic constriction nerve injury model of peripheral neuropathy and the formalin model of tonic inflammatory pain. The desirable (analgesic) properties resided predominantly in the S(-)- rather than the R(+)-enantiomer. In contrast, undesirable effects (motor in-coordination, reduced locomotor activity, ataxia) were more pronounced with the R(+)-enantiomer. This is an interesting finding, which may suggest separation of toxicity from analgesia by utilization of S(-)-enantiomer of nornicotine. Maximum analgesic effectiveness without significant side-effects was achieved when S(-)-nornicotine (sub-analgesic dose) was combined with a low-dose of the micro-opioid, morphine. These preclinical data suggest that S(-)-nornicotine may be of value, either alone or in combination with an opioid, for treatment of a broad-spectrum of pain (i.e. nociceptive, neuropathic, and mixed pain).
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Affiliation(s)
- Joseph R Holtman
- Anesthesiology/Pain Medicine, College of Medicine, University of Kentucky, Lexington KY 40536, United States.
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[Management of transdermal therapeutics in perioperative care]. ACTA ACUST UNITED AC 2009; 28:311-20. [PMID: 19304449 DOI: 10.1016/j.annfar.2009.01.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2008] [Accepted: 01/14/2009] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To provide guidance on perioperative management of most frequently encountered transdermal therapeutics in anaesthesiology: nicotine, fentanyl, nitroglycerin, scopolamine and estradiol. DATA SOURCES A review of the last decade literature was carried out on the Pubmed database using the following keywords (transcutaneous or percutaneous or transdermal or transdermic or skin or dermal) and (drug delivery systems or therapeutic systems or drug administration) grouped under the Mesh terms cutaneous administration, perioperative care, surgery, pharmacokinetics, nicotine, fentanyl, nitroglycerin, scopolamine, estradiol. STUDY SELECTION Original articles, general articles reviews, guidelines, letters to the editor and case reports have been selected. DATA EXTRACTION Articles were analyzed for each transdermal treatment in terms of pharmacokinetics as well as anaesthetics and surgical interactions. DATA SYNTHESIS Transdermal nicotine must be removed before anaesthesia of patients with coronary disease or with high risk of inhalation and in case of reconstructive surgery. Transdermal fentanyl must be maintained during the perioperative period and associated with preventive treatments of hyperalgesia. Transdermal administration of fentanyl by iontophoresis is a promising system for postoperative analgesia. Transdermal nitroglycerin must be maintained before scheduled surgery of a coronary patient. Transdermal scopolamine must be removed the day before surgery because of its side effects. It could have an interest in the prevention of postoperative nausea and vomiting, but its therapeutic method remain to be defined. Transdermal estradiol can be maintained during the perioperative period. CONCLUSION The management of transdermal therapeutics in peri operative care can be adapted for each treatment and for each patient by knowing pharmacokinetics as well as anaesthetics and surgical interactions. In emergency situations, the actions to be taken do not generally differ, but one must be aware that the effects of trandermal treatments do not disappear immediately when removed, due to their pharmacokinetics properties.
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Sterling JA. Recent Publications on Medications and Pharmacy. Hosp Pharm 2008. [DOI: 10.1310/hpj4311-937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Hospital Pharmacy presents this feature to keep pharmacists abreast of new publications in the medical/pharmacy literature. Articles of interest regarding a broad scope of topics are abstracted monthly.
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