There is a general decline in smoking prevalence in India from 27 to 24%, the absolute numbers of male smokers aged 15–69 years has increased substantially over the last 15 years. The forced abstinence from smoking in hospital might trigger nicotine withdrawal, results in hyperalgesia or lower pain threshold after surgical procedures. Previous studies on the effect of nicotine replacement therapy with transdermal patch have shown no benefit in the improvement of pain scores.

Aims
To compare the effect of nicotine replacement therapy in spinal fusion patients.

Methodology
Sixty abstinent tobacco smokers planned for spinal fusion were recruited and randomized into Group A (n=31) and Group B (n=29). Transdermal nicotine patch (21 mg) was applied one day prior to surgery till 48 hours after surgery. Perioperative baseline data and NRS score were recorded. Nicotine concentration was measured from pre and postoperative serum samples using ELISA. Graph pad prism and linear regression analysis were done to measure the nicotine concentration and to plot the standard curve respectively.

The mean age ± SD of Group A and Group B patients was 41.36 ± 14 and 41.72 ± 11.8 years, respectively. No significant difference in perioperatively baseline variables were observed. Pre (p=0.0003) and post operative (p=0.006) NRS score was significant. Wilcoxon rank-sum (Mann- Whitney) test found the significant effect (<0.001) of nicotine concentration in the postoperative group. 

The administration of transdermal nicotine patch (21 mg) one day prior to surgery resulted in a significant reduction in postoperative pain scores.