Nicotine Patch for the Prevention of Postoperative Nausea and Vomiting

Abstract and Introduction

Background and objective: It has been demonstrated that smoking significantly reduces postoperative nausea and vomiting (PONV). However, there are approximately 4000 substances in cigarette smoke that can be responsible for this effect. To demonstrate whether nicotine is the substance with antiemetic effects we applied a nicotine patch in patients undergoing laparoscopic cholecystectomy under general anaesthesia.
Methods: Seventy-five patients classified as ASA (American Society of Anesthesiologists' classification) I/II were divided in three groups: group 1 (n = 25), which comprised non-smokers; group 2 (n = 25), which comprised patients who had given up smoking for the last 5 years and received perioperatively a nicotine patch that contained 16.6mg nicotine/patch; and group 3 (n = 25), which comprised actual smokers. Postoperatively, the incidence of PONV and the need for antiemetic rescue medication were monitored every 6 hours.
Results: We found a significant reduction in the incidence of PONV in group 2 (5/25 [20%], p = 0.0001 vs group 1) and group 3 (8/25 [32%], p = 0.002 vs group 1) compared with group 1 (18/25 [76%]). The difference in incidence of PONV between group 2 and group 3 was not significant (p > 0.05).
Conclusions: Nicotine significantly reduced the incidence of PONV after laparoscopic cholecystectomy.

There are numerous studies in the literature about the serious adverse effects and complications of smoking, many of which represent perioperative risks. An increased incidence of postoperative nausea and vomiting (PONV) should be also considered, as initiation of smoking produces nausea,^[1] and nausea is one of the adverse effects associated with use of transdermal nicotine.^[2] However, Cohen et al.^[3] and later Koivuranta et al.^[4] and Hough and Sweeney^[5] identified smoking as a protective factor against PONV, and Apfel et al.^[6] found that non-smoking represents one of the four most important risk factors for PONV, together with female gender, history of PONV or motion sickness, and use of opioids postoperatively. Chimbira and Sweeney^[7] confirmed the antiemetic effect of smoking in a study of 327 consecutive patients undergoing arthroscopic day-case knee surgery, as did others.^{[8,9,10,11,12]}

In a previous report we showed that smoking significantly reduced the incidence of PONV after laparoscopic cholecystectomy as well as the severity of postoperative pain.^[13] The mechanism of the antiemetic effect of smoking is unknown, as it is not known what substance among the approximately 4000 substances in cigarette smoke is responsible for this effect.^[14] The objective of this study was to test if nicotine is the substance responsible for the antiemetic and analgesic effects of smoking. This hypothesis has not been tested before. To study this, we used a transdermal nicotine patch (Nicorette^®, GlaxoSmithKline Consumer Healthcare),¹ which is extensively used for smoking withdrawal and has a low incidence of associated adverse effects.^[15]

Clin Drug Invest. 2007;27(8):559-564. © 2007 Adis Data Information BV

Cite this: Nicotine Patch for the Prevention of Postoperative Nausea and Vomiting - Medscape - Aug 01, 2007.