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Analgesic potential of transdermal nicotine patch in surgery: a systematic review and meta-analysis of randomised placebo-controlled trials

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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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Data availability

The datasets used or analysed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

The authors acknowledge the financial support provided by the following Brazilian funding agencies: Coordination for the Improvement of Higher Education (CAPES), National Council for Scientific and Technological Development (CNPq) and Science and Technology Support Foundation of the State of Pernambuco (FACEPE). We would also like to thank the University of Pernambuco (UPE) and São Paulo State University (UNESP) for all their support.

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Authors and Affiliations

  1. Division of Oral and Maxillofacial Surgery, Dental School, University of Pernambuco (UPE), Arnóbio Marques St., 310, Recife, PE, 50100-130, Brazil

    Davi da Silva Barbirato & Belmiro Cavalcanti do Egito Vasconcelos

  2. Federal University of Pernambuco (UFPE), Recife, PE, Brazil

    Amanda Freire de Melo Vasconcelos

  3. Faculty of Dentistry, University of Pernambuco (UPE), Camaragibe, PE, Brazil

    Sandra Lúcia Dantas de Moraes

  4. Department of Dental Materials and Prosthodontics, São Paulo State University (UNESP), Araçatuba, Brazil

    Eduardo Piza Pellizzer

  5. Oral and Maxillofacial Surgery at Hospital da Restauração, Recife, PE, Brazil

    Belmiro Cavalcanti do Egito Vasconcelos

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  1. Davi da Silva Barbirato
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All authors made substantial contribution to the conception and design of the manuscript. DSB, AFMV, and BCEV performed the literature search and interpretation of the data. All authors drafted the work and revised it critically for important intellectual content. All authors agree to be accountable for all aspects of the study design and its content. All authors approved the final submitted version.

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Correspondence to Belmiro Cavalcanti do Egito Vasconcelos.

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da Silva Barbirato, D., de Melo Vasconcelos, A.F., Dantas de Moraes, S.L. et al. Analgesic potential of transdermal nicotine patch in surgery: a systematic review and meta-analysis of randomised placebo-controlled trials. Eur J Clin Pharmacol 79, 589–607 (2023). https://doi.org/10.1007/s00228-023-03475-7

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