Transdermal nicotine patch as adjunctive analgesic modality to thoracic epidural analgesia for post-thoracotomy pain

Objective
The aim of the study was to evaluate the applicability of transdermal nicotine patch (TNP) as an analgesic modality adjunctive to thoracic epidural analgesia (TEA) for patients undergoing thoracotomy.
Patients and methods
The current study included 100 adult nonsmoker male patients assigned to undergo thoracotomy and resection for lung cancer. Patients were randomly allocated into two equal groups: group N received TNP (5 mg/16 h) applied to glabrous skin immediately before induction of anesthesia and group C included patients who received placebo patch. All patients received bupivacaine (0.125%) TEA initiated at the time of induction of anesthesia until 48 h postoperative (PO). All patients received a β-lactam antibiotic as prophylactic and PO antibiotic. Rescue analgesia was provided as increments of dose of epidural bupivacaine until 48 h PO, and thereafter as intravenous meperidine 50 mg. PO pain was assessed using 10-point visual analog scale (VAS) and rescue analgesia was given if VAS was greater than 4. Intraoperative variability of heart rate and blood pressure measures, the frequency of requests for PO rescue analgesia, and the frequency of postoperative nausea and vomiting (PONV) were recorded.
Results
Epidural analgesia induced significant decrease in systolic arterial blood pressure and mean arterial blood pressure estimated at the end of surgery in both groups. Nicotine induced significantly higher heart rate compared with baseline measures in group N. Mean systolic arterial blood pressure and mean arterial blood pressure measures estimated at the end of surgery were significantly higher in group N compared with group C. Pain VAS scores were significantly lower in group N compared with group C throughout the first 48 h after admission to ICU, but thereafter pain VAS scores were significantly higher as against that determined at 48 h after ICU admission, in both groups. Pain VAS scores were significantly lower in group N compared with group C after removal of epidural catheter until 80 h after the end of surgery. The number of requests of rescue analgesia was significantly higher in group C compared with group N. TNP significantly reduced the number of requests of rescue analgesia after removal of epidural catheter in comparison with placebo. The frequency of PONV was significantly higher in group N compared with group C.
Conclusion
TNP could be considered as appropriate adjuvant analgesic to TEA for patients who had thoracotomy during early PO period and could be used as the sole analgesic after cessation of TEA. Prophylactic antiemetics were advocated to guard against the high possibility of development of PONV.