***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND : A single 3 mg intranasal dose of nicotine has been reported to have analgesic properties . We design ed placebo-controlled study to test the hypothesis that transdermal nicotine ( TDN ) administered over a 3-day period would decrease postoperative pain and opioid analgesic usage and improve the recovery process after lower abdominal surgery . METHODS : Ninety-seven patients undergoing abdominal hysterectomy procedures were r and omly assigned to one of two treatment groups : ( 1 ) control group received inert ( sham ) patches 1 h before and for 2 days after surgery , or the ( 2 ) nicotine group received TDN 30 ( 21 mg nicotine ) patches 1 h before induction of anesthesia and for two additional days after surgery . The anesthetic technique was identical in both groups , and the postoperative assessment s included verbal rating scales for pain and sedation , IV patient-controlled analgesia morphine usage , quality of recovery assessment , recovery of bowel function , resumption of normal activities , and patient satisfaction with their pain management . Follow-up evaluations were performed at 1 and 3 mo after the operation to assess late recovery events . RESULTS : Postoperative patient-controlled analgesia morphine usage and pain scores while supine or sitting up , intraoperative fentanyl use , oral analgesic consumption , return of bowel sounds , and passage of flatus did not differ between the two groups . Although ambulation and hospitalization times , as well as quality of recovery scores , did not differ , resumption of oral intake was delayed in the nicotine group . Discharge eligibility scores were higher in the nicotine group at 48 and 72 h compared with the control group , but the time to return to work was 19 days in both treatment groups . CONCLUSIONS : Perioperative administration of a high-dose TDN patch did not improve postoperative pain control or decrease the analgesic requirement after pelvic gynecological surgery . Despite delayed resumption of oral intake , more patients in the nicotine group were ready for discharge at 48 and 72 h after surgery . However , times to resuming activities of daily living were similar in both groups Postoperative pain can have a significant effect on patient recovery . An underst and ing of patient attitudes and concerns about postoperative pain is important for identifying ways health care professionals can improve postoperative care . To assess patients ’ postoperative pain experience and the status of acute pain management , we conducted a national study by using telephone question naires . A r and om sample of 250 adults who had undergone surgical procedures recently in the United States was obtained from National Family Opinion . Patients were asked about the  severity of postsurgical pain , treatment , satisfaction with pain medication , patient education , and perceptions about postoperative pain and pain medications .  Approximately 80 % of patients experienced acute pain after surgery . Of these patients , 86 % had moderate , severe , or extreme pain , with more patients experiencing pain after discharge than before discharge . Experiencing postoperative pain was the most common concern ( 59 % ) of patients . Almost 25 % of patients who received pain medications experienced adverse effects ; however , almost 90 % of them were satisfied with their pain medications . Approximately two thirds of patients reported that a health care professional talked with them about their pain . Despite an increased focus on pain management programs and the development of new st and ards for pain management , many patients continue to experience intense pain after surgery . Additional efforts are required to improve patients ’ postoperative pain experience 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 r and omly allocated to Nicotinell Patch 10cm(2 ) ( TTS 10 ) , containing 17.5 mg of nicotine ( average delivery rate , 7 mg 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 ) . RESULTS We r and omized 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 ) . CONCLUSIONS Non-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 The subjective experience of nicotine , which may be influenced by personality traits as well as environmental factors , may be important for underst and ing the factors associated with the initiation and maintenance of nicotine dependence . The present study examined the effects of 7 mg transdermal nicotine  among a relatively large sample ( n = 91 ; 44 women ) of college-aged nonsmokers . Using a placebo controlled , double-blind , within-subjects design , nicotine 's effects were examined at rest and again after participants completed a sustained attention task . Sex and personality factors ( Behavioral Inhibition and Behavioral Approach ; BIS/BAS Scales ; Carver & White , 1994 ) were examined as potential moderators . Overall , the effects of nicotine were generally modest and unpleasant . In the context of the cognitive task , nicotine increased nausea and negative affect but reduced fatigue , relative to placebo . In contrast , effects of nicotine during the initial 4 hr of patch administration , in which participants were in their natural environments , were moderated by individual differences in behavioral approach . Neither behavioral inhibition nor gender reliably moderated any subjective effects of nicotine . The present work suggests transdermal nicotine exerts only modest , mostly negative effects among nonsmokers . Future work should examine both context ual and personality moderators in large sample s of participants who are exposed to nicotine through multiple routes of administration OBJECTIVES To determine the minimum clinical ly significant difference in visual analog scale ( VAS ) pain scores for acute pain in the ED setting and to determine whether this difference varies with gender , age , or cause of pain . METHODS A prospect i ve , descriptive study of 152 adult patients presenting to the ED with acute pain . At presentation and at 20-minute intervals to a maximum of three measurements , patients marked the level of their pain on a 100-mm , nonhatched VAS . At each follow-up they also gave a verbal rating of their pain as " a lot better , " " much the same , " " a little worse , " or " much worse . " The minimum clinical ly significant difference in VAS pain scores was defined as the mean difference between current and preceding scores when pain was reported as a little worse or a little better . Data were compared based on gender , age more than or less than 50 years , and traumatic vs nontraumatic causes of pain . RESULTS The minimum clinical ly significant difference in VAS pain scores is 9 mm ( 95 % CI , 6 to 13 mm ) . There is no statistically significant difference between the minimum clinical ly significant differences in VAS pain scores based on gender ( p=0.172 ) , age ( p=0.782 ) , or cause of pain ( p=0.84 ) . CONCLUSIONS The minimum clinical ly significant difference in VAS pain scores was found to be 9 mm . Differences of less than this amount , even if statistically significant , are unlikely to be of clinical significance . No significant difference in minimum significant VAS scores was found between gender , age , and cause-of-pain groups Background : Despite pharmacological treatment , 70–80 % of patients report moderate to severe pain after surgery . Because nicotine has been reported to have analgesic properties in animal and human volunteer studies , the authors assessed the analgesic efficacy of a single 3 mg dose of nicotine nasal spray administered before emergence from general anesthesia . Methods : The authors conducted a r and omized , double blind , placebo controlled trial of 20 healthy women ( mean age 45 ( SD 8) yr ) who were to undergo uterine surgery through a low transverse incision .  After the conclusion of surgery but before emergence from general anesthesia , the anesthesiologist administered either nicotine nasal spray or a placebo . Numerical analog pain score and morphine utilization and hemodynamic values were measured for 24 h. Results : The patients treated with nicotine reported lower pain scores during the first hour after surgery ( peak numerical analog score , 7.6 ( SD 1.4 ) versus 5.3 ( SD 1.6 ) ; P < 0.001 ) and used half the amount of morphine as the control group ( 12 ( SD 6 ) versus 6 ( SD 5 ) mg ; P < 0.05 ) . Patients who received nicotine still reported less pain than those in the control group 24 h after surgery ( 1.5 ( SD 0.5 ) versus 4.9 ( SD 1.4 ) ; P < 0.01 ) . Systolic blood pressure was lower in the group that received nicotine ( 105 ( SD 3 ) versus 122 ( SD 3 ) ; P < 0.001 ) , but there was no difference in diastolic blood pressure or heart rate . Conclusions : Treatment with a single dose of nicotine immediately before emergence from anesthesia was associated with significantly lower reported pain scores during the first day after surgery . The decreased pain was associated with a reduction in morphine utilization and the analgesic effect of nicotine was not associated with hypertension or tachycardia BACKGROUND A nasal spray form of nicotine replacement therapy ( Nicotrol NS , McNeil Consumer Products Co , Fort Washington , Pa ) has been approved and , because of its rapid absorption across the nasal mucosa , may be more effective than nicotine gum or transdermal patches . We tested the hypothesis that the nicotine absorbed into the nasal mucosa would produce significant changes in hemodynamics and pulmonary function in 20 healthy , nonsmoking men and women . METHODS In this double-blind , r and omized study of Nicotrol NS versus placebo , we measured serum nicotine concentrations , blood pressure , heart rate , and indices of pulmonary function at timed intervals before and after nasal spray administration of 3 mg of nicotine . RESULTS A peak serum nicotine concentration of 4.71 + /- 3.16 ng/mL occurred 10 minutes after drug administration . The maximum change in systolic blood pressure occurred 5 minutes after dosing and was significantly related to nicotine administration ( 7.1 + /- 9.4 % for the nicotine group vs -1.6 + /- 7.3 % for the placebo ; P = 0.03 ) . In contrast , neither diastolic blood pressure ( P = 0.8 ) nor heart rate ( P = 0.07 ) changed significantly after nicotine administration , when compared with placebo .  Pulmonary function was not altered acutely by a single inhalation of nicotine . Pharmacokinetic modeling revealed a classic one-compartment model in which nicotine is absorbed into the systemic circulation by a zero-order process and eliminated by a first-order process . CONCLUSIONS In this population of nonsmokers , hemodynamic effects of the nicotine nasal spray were observed shortly after administration and before the peak serum nicotine concentration BACKGROUND : Nicotine has an antinociceptive effect in animal models . The analgesic effect in humans has been examined , but studies have had mixed results . A proposed etiology is variability in chronic nicotine exposure because of differences in tobacco smoking rates and second-h and smoke exposure . In this study , we examined the postoperative analgesic effect of a transdermal nicotine patch in smokers in a parallel design to a previous study in nonsmokers . METHODS : We conducted a r and omized , double-blind , prospect i ve , placebo-controlled trial of 28 patients undergoing abdominal or pelvic surgery who required patient-controlled analgesia and an overnight hospital stay . Before anesthetic induction , a transdermal nicotine patch was applied ( 0 , 5 , 10 , or 15 mg ) . The primary outcome variable was postoperative pain reported over the first hour and over the next 5 days using a st and ard numerical rating scale . Secondary outcome variables were pain medication use , hemodynamic values , nausea , and sedation . RESULTS : Patients treated with nicotine reported higher pain scores than those treated with placebo over the first hour after surgery ( P < 0.01 , average numerical rating scale increase = 0.67 ) and there was no difference between groups in the subsequent 5 days ( P > 0.05 ) . There was no significant dose effect . Diastolic blood pressure in the first hour was higher in the placebo group compared with the nicotine-treated group ( P < 0.01 , average increase = 11 mm Hg ) . There was no difference in nausea 
    Output:
    
: This systematic review suggests that perioperative nicotine administration was associated with a statistically significant reduction in cumulative opioid consumption at 24 hours and a statistically insignificant reduction in pain scores at 24 hours .
Perioperative nicotine was also associated with an increased incidence of postoperative nausea in patients undergoing surgery under general anesthesia .
The opioid-sparing effect seemed to be limited to nonsmokers .
Current data do not support a role for nicotine in perioperative analgesia