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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

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An Erratum to this article was published on 03 July 2015

Abstract

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.

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Acknowledgments

We are grateful for the multiple contributions of the Mayo Clinic staff, residents, and nurses in the Departments of Anesthesiology and the Division of General Surgery. We are also grateful to Ms. Laurie Meade, study coordinator, Anesthesia Clinical Research Unit.

Conflict of Interest

The authors declare that they have no competing interests.

Statement of Informed Consent

Informed consent was obtained from all individual participants included in the study.

Statement of Human and Animal Rights

All procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Authors and Affiliations

  1. Mayo Clinic Department of Anesthesiology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN, 55905, USA

    Toby N. Weingarten, Brian P. McGlinch & Juraj Sprung

  2. Mayo Clinic Anesthesia Clinical Research Unit, Mayo Clinic Department of Anesthesiology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN, 55905, USA

    Lavonne Liedl

  3. Mayo Clinic Department of Surgery, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN, 55905, USA

    Michael L. Kendrick & Todd A. Kellogg

  4. Mayo Clinic Department of Biomedical Statistics and Informatics, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN, 559051, USA

    Darrell R. Schroeder

Authors
  1. Toby N. Weingarten
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  2. Brian P. McGlinch
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  3. Lavonne Liedl
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  4. Michael L. Kendrick
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  5. Todd A. Kellogg
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  6. Darrell R. Schroeder
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  7. Juraj Sprung
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Corresponding authors

Correspondence to Toby N. Weingarten or Juraj Sprung.

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Intramural grant from the Mayo Foundation.

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Weingarten, T.N., McGlinch, B.P., Liedl, L. et al. 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 25, 506–513 (2015). https://doi.org/10.1007/s11695-014-1431-7

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  • DOI: https://doi.org/10.1007/s11695-014-1431-7

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