Comparative study between transdermal nicotine and melatonin patches on postoperative pain relief after laparoscopic cholecystectomy, a double-blind, placebo-controlled trial

Peer review under responsibility of Egyptian Society of Anesthesiologists.

Figures & data

able 1 Ramsay sedation score.

Score	Observation
1	Anxious, agitated or restless
2	Cooperative, oriented and tranquil
3	Responsive to commands
4	Asleep, but with brisk response to light glabellar tap or loud auditory stimulus
5	Asleep, sluggish response to glabellar tap or auditory stimulus
6	Asleep, no response

igure 1 A 7-point Likert-like verbal rating scale for assessment of patients’ and surgeons’ satisfaction.

able 2 Intraoperative bleeding score classification.

Score	Descriptions
0	No bleeding
I	Slight bleeding, no suctioning of blood required
II	Slight bleeding, occasional required suctioning. Surgical field not threatened
III	Slight bleeding, frequent suctioning required. Bleeding threatens surgical field a few seconds after suction is removed
IV	Moderate bleeding, frequent suctioning required. Bleeding threatens surgical field directly after suction is removed
V	Severe bleeding, constant suctioning required. Bleeding rate is faster than its removal by suctioning as surgical field is severely threatened and surgery becoming impossible

igure 2 Flowchart of patients (study design).

able 3 The demographic data.

Variables	C group (n = 20)	TDN group (n = 20)	TDM group (n = 20)	p-value
Age (yr.)	43.6 ± 3.39	43.1 ± 2.4	44.3 ± 1.86	0.357
Weight (kg)	76.4 ± 6.5	77.45 ± 5.1	78.15 ± 2.9	0.188
Height (cm)	168.4 ± 3.4	171.2 ± 3.4	167.5 ± 72.9	0.2
ASA (I/II)	11/9	13/7	12/8	0.9
Duration of anesthesia (min)	111.2 ± 3.4	112.8 ± 4.4	111.4 ± 3.78	0.756

Data were presented as mean ± SD. ASA: American Society of Anesthesiologists.

P > 0.05 was considered statistically non-significant between the 3 groups.

igure 3 The heart rate changes (beats/minute). Lines are mean HR and error bars are SD.

igure 4 The mean arterial blood pressure changes (mmHg). Lines are mean MABP and error bars are SD. *denotes significant difference.

igure 5 Sedation score (Ramsay sedation score). The middle black solid line represents the median RSS score, the upper and lower margins of the boxes are (IQR) and the whiskers are minimum and maximum.

igure 6 Visual analogue scale (VAS). Columns are median and error bars are (IQR). *denotes significant difference.

able 4 Postoperative data.

Postoperative Data.	C group (n = 20)	TDN group (n = 20)	TDM group (n = 20)	p-value
Time for 1st rescue analgesic (minutes) postop	50 .8 ± 19.56^†	231.5 ± 11.6	212 ± 12.6	<0.001^⁎
Total pethidine requirements (mg) 12 h postop	122.15 ± 6.38^†	55.5 ± 3.97	59.7 ± 4.43	<0.001^⁎
Serum cortisol 2 h postop. (μg/dl)	30.85 ± 3.57^†	20.8 ± 3.3	20.65 ± 3. 69	<0.001^⁎
Patient’s satisfaction score	2 (2–2.75) ^†	6 (4.25–6)	6 (5–6)	<0.001^⁎
Intraoperative bleeding (0–2)	15(60%)	17(68%)	20(80%)^‡	0.021^⁎
Surgeon’s satisfaction score	4 (4–4.75)	4 (4–4.75)	7 (6–7)^‡	<0.001^⁎

Data are presented as mean (SD), median (interquartile range) or number (%).

P < 0.001 is considered statistically significant between the 3 groups.

#x204E; Denotes significant difference.

#x2020; P < 0.001 was considered statistically significant between TDN and TDM groups and C group.

#x2021; P < 0.001 was considered statistically significant between C and TDN groups and TDM group.