Transcutaneous nicotine does not prevent postoperative nausea and vomiting: a randomized controlled trial.

center dot There is empirical evidence that smokers are less likely to suffer from postoperative nausea and vomiting (PONV). center dot Tobacco smoke is known to induce enzymes, for instance, cytochrome P450, and this may partially explain the PONV-protecting effect of smoking. center dot Chronic exposure to nicotine that is contained in the tobacco may lead to a desensitization of central nicotine receptors, and, subsequently, to an increased tolerance to the emetogenic effects of surgery and anaesthesia. WHAT THIS STUDY ADDS center dot In non-smokers undergoing surgery under general anaesthesia, pre-operatively administered transcutaneous nicotine did not decrease the incidence of PONV within 24 h. center dot Patients receiving nicotine had a tendency to develop PONV symptoms earlier than controls. center dot Exposure to transcutaneous nicotine significantly increased the risk of insomnia during the first postoperative night. AIMS There is empirical evidence that smokers are less likely to suffer from postoperative nausea and vomiting (PONV). We sought to investigate whether transcutaneus nicotine prevents PONV. METHODS Non-smokers receiving general anaesthesia for surgery were randomly allocated to Nicotinell (R) Patch 10 cm2 (TTS 10), containing 17.5 mg of nicotine (average delivery rate, 7 mg 24 h-1) or matching placebo patch. Patches were applied 1 h before surgery and were left in situ until 24 h after surgery (or until the first PONV symptoms occurred). RESULTS We randomized 90 patients (45 nicotine, 45 placebo). In the post-anaesthetic care unit, the incidence of nausea was 22.2% with nicotine and 24.4% with placebo (P = 0.80), and the incidence of vomiting was 20.0% with nicotine and 17.8% with placebo (P = 0.78). Cumulative 24 h incidence of nausea was 42.2% with nicotine and 40.0% with placebo (P = 0.83), and of vomiting was 31.1% with nicotine and 28.9% with placebo (P = 0.81). PONV episodes tended to occur earlier in the nicotine group. Postoperative headache occurred in 17.8% of patients treated with nicotine and in 15.6% with placebo (P = 0.49). More patients receiving nicotine reported a low quality of sleep during the first postoperative night (26.7% vs. 6.8% with placebo; P = 0.01). CONCLUSIONS Non-smokers receiving a prophylactic nicotine patch had a similar incidence of PONV during the first 24 h and tended to develop PONV symptoms earlier compared with controls. They had a significantly increased risk of insomnia during the first postoperative night.