Nicotine Patch Decreases Post-Surgical Pain

While morphine and other opioids (narcotics) remain the most commonly prescribed post-operative pain medications, many patients fear the side effects from these drugs, which can include drowsiness, nausea, slowed breathing, vomiting, constipation, itching and dependence.

“Some patients would rather experience the pain than the potential side effects of morphine and other painkillers,” said Ashraf S. Habib, M.D., associate professor of anesthesiology and director of quality improvement, Duke University Medical Center, Durham, North Carolina.

Dr. Habib’s study included 90 non-smoking men about to undergo a radical retropubic prostatectomy. Each received a 7-milligram nicotine patch or an identical placebo patch before anesthesia and surgery. After surgery, each patient was able to access morphine through a self-controlled device.

The patients who received the nicotine patch self-administered significantly less morphine in the postoperative period. In general, the nicotine patch was well-tolerated by patients, however, patients receiving nicotine reported higher levels of nausea.

“The study suggests that the nicotine patch has a useful effect in improving pain relief after surgery,” Dr. Habib said.

Several previous studies have shown the pain-relief benefits of nicotine. In one study, a small dose of nicotine (3 milligrams) was given post-surgically, via a nicotine spray, to hysterectomy patients. These patients reported less pain and less need for morphine.

Future studies could determine whether nicotine is better administered in a patch or spray form, Dr. Habib said, as well as the effectiveness of nicotine in “smokers versus non-smokers and women versus men.”

In addition, different doses of the patch should be tested to identify the ideal amount of nicotine to produce optimal pain relief with minimal or no side effects.