• Christoph Czarnetzki, Eduardo Schiffer, Christopher Lysakowski, Guy Haller, Daniel Bertrand, and Martin R Tramèr.
• Division of Anaesthesiology Clinical Trial Unit, University Hospitals of Geneva, Geneva, Switzerland Department of Neurosciences Medical Faculty, University of Geneva, Geneva, Switzerland. christoph.czarnetzki@hcuge.ch
• Br J Clin Pharmacol. 2011 Mar 1;71(3):383-90.

AimsThere 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.MethodsNon-smokers receiving general anaesthesia for surgery were randomly allocated to Nicotinell Patch 10cm(2) (TTS 10), containing 17.5mg of nicotine (average delivery rate, 7mg 24h(-1) ) or matching placebo patch. Patches were applied 1h before surgery and were left in situ until 24h after surgery (or until the first PONV symptoms occurred).ResultsWe 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 24h 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).ConclusionsNon-smokers receiving a prophylactic nicotine patch had a similar incidence of PONV during the first 24h and tended to develop PONV symptoms earlier compared with controls. They had a significantly increased risk of insomnia during the first postoperative night.© 2011 The Authors. British Journal of Clinical Pharmacology © 2011 The British Pharmacological Society.

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