Summary of findings for the main comparison. Transdermal or intranasal nicotine versus placebo for the treatment of postoperative pain.
| Main outcomes: Transdermal or intranasal nicotine versus placebo for the treatment of postoperative pain | ||||||
|
Patient or population: people being treated for postoperative pain
Settings: postsurgical inpatients
Intervention: transdermal or intranasal nicotine Comparison: placebo | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| Control | Main outcomes: transdermal or intranasalnicotine versus placebo | |||||
| Pain at 60 minutes | The mean pain at 60 minutes in the control groups was 3.1 to 6.5 points | The mean pain at 60 minutes in the intervention groups was 0.14 lower (0.94 lower to 0.65 higher) | MD ‐0.14 (‐0.94 to 0.65) | 442 (6 studies) | ⊕⊝⊝⊝ very low1,2,3 | ‐ |
| Pain at 12 hours | The mean pain at 12 hours in the control groups was 1.7 to 1.9 points | The mean pain at 12 hours in the intervention groups was 0.14 lower (0.98 lower to 0.98 higher) | MD ‐0.00 (‐0.98 to 0.98) | 175 (2 studies) | ⊕⊝⊝⊝ very low1, 3, 4 | ‐ |
| Pain at 24 hours | The mean pain at 24 hours in the control groups was 0.6 to 5.3 points | The mean pain at 24 hours in the intervention groups was 0.88 lower (1.58 to 0.18 lower) | MD ‐0.88 (‐1.58 to ‐0.18) | 562 (8 studies) | ⊕⊕⊝⊝ low1, 4 | ‐ |
| Hourly morphine equivalents at 60 minutes | The mean hourly morphine equivalents at 60 minutes in the control groups was 0.5 to 1.3 mg morphine equivalents | The mean hourly morphine equivalents at 60 minutes in the intervention groups was 0.08 lower (0.4 lower to 0.24 higher) | MD ‐0.08 (‐0.40 to 0.24) | 168 (4 studies) | ⊕⊕⊝⊝ low1, 3 | ‐ |
| Hourly morphine equivalents at 24 hours | The mean hourly morphine equivalents at 24 hours in the control groups was 30.2 to 51.6 mg morphine equivalents | The mean hourly morphine equivalents at 24 hours in the intervention groups was 6.06 lower (12.91 lower to 0.79 higher) | MD ‐6.06 (‐12.91 to 0.79) | 168 (4 studies) | ⊕⊕⊝⊝ low1,3 | ‐ |
| Sedation score | The mean sedation score in the control groups was ‐1 to 19.21 | The mean sedation score in the intervention groups was 0.13 standard deviations lower (0.88 lower to 0.62 higher) | SMD ‐0.13 (‐0.88 to 0.62) | 148 (3 studies) | ⊕⊕⊝⊝ very low1,2,3 | ‐ |
| Nausea | Study population | RR 1.24 (1.03 to 1.5) | 592 (7 studies) | ⊕⊕⊕⊝ moderate1 | ‐ | |
| 379 per 1000 | 469 per 1000 (390 to 568) | |||||
| 400 per 1000 | 496 per 1000 (412 to 600) | |||||
| Vomiting | Study population | RD 0.03 (‐0.04 to 0.09) | 602 (7 studies) | ⊕⊕⊝⊝ low1,3 | ‐ | |
| 150 per 1000 | 176 per 1000 (110 to 241) | |||||
| 65 per 1000 | 76 per 1000 (47 to 104) | |||||
| Time to hospital discharge | The mean time to hospital discharge in the control groups was 45.5 hours | The mean time to hospital discharge in the intervention groups was 1.2 hours longer (6.19 shorter to 8.59 longer) | MD 1.20 (‐6.19 to 8.59) | 90 (1 study) | ⊕⊕⊝⊝ very low1,5 | ‐ |
| GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate. CI: confidence interval; MD: mean difference; SMD: standardized mean difference; RD: risk difference; RR: risk ratio. | ||||||
1 Downgraded one level due to serious risk of bias: methodological limitations present in most studies. 2 Downgraded one level due to serious inconsistency: statistical heterogeneity was 50‐75%. 3 Downgraded one level due to serious imprecision: the confidence interval around the effect includes benefit and harm.
4 Downgraded one level due to serious inconsistency: statistical heterogeneity was 75‐100%.
5 Downgraded two levels due very serious imprecision: evidence comes from one small study and the confidence interval around the effect included a clinically meaningful effect with intervention or control.