Pre-emptive Use of Transdermal Nicotine Patch in Lumber Disc Surgery: It’s Effects on Intraoperative Anaesthetic and Analgesic Requirements, Haemodynamics and Postoperative Analgesia

Nicotine has been reported to have analgesic effects in animal and human studies. This study evaluated the effect of pre-emptive use of transdermal nicotine patch on intraoperative sevoflurane and fentanyl requirements, perioperative haemodynamics and postoperative analgesia in patients undergoing lumber disc surgery. Fifty non-smokers patients (ASA I and II) undergoing lumber discectomy were randomly allocated to receive either 7 mg nicotine patch (nicotine group n=25) or placebo patch (control group n=25) two hours before surgery. The anaesthetic technique was identical in both groups. All operations were done by the same surgeon. Intraoprative fentanyl requirement and sevoflurane concentration needed to maintain bispectral index between 40-50 were evaluated. Patients used a patient controlled analgesia device to receive bolus dose of morphine after surgery. Perioperative haemodynamics (mean arterial pressure and heart rate), cumulative morphine consumption, pain scores, sedation scores and respiratory rate were measured for 24 hours postoperatively. Incidence of adverse effects and patients’ satisfaction with their pain management were also recorded. Nicotine patch application resulted in significant reduction of intraoperative fentanyl requirement and postoperative cumulative morphine consumption at 8, 12, and 24 hours (P<0.05). The groups were similar with respect to sevoflurane requirement, perioperative haemodynamics, postoperative sedation scores and pain scores measured in supine or sitting position. Number of patients experienced postoperative respiratory depression (respiratory rate<10 breath/min) and itching was significantly higher in control group than nicotine group (P<0.05). The incidence of postoperative nausea and vomiting, and number of patients receiving antiemetic treatment in the first postoperative 24 h were reduced in nicotine group than control group but this reduction was statistically insignificant (P>0.05). Patient satisfaction was better in nicotine group compared with the control group (p=0.05). Pre-emptive application of 7 mg transdermal nicotine patch provided significant reduction of intraand post-operative opioid requirements associated with decreased incidence of opioid related adverse effects in patients undergoing lumber disc surgery. However, it had no effect on sevoflurane requirement or perioperative haemodynamics.