Oral choline supplementation for postoperative pain.
What this study found
Perioperative oral choline did not improve postoperative pain or blunt the inflammatory response versus placebo. Pain at rest and with movement was not different at 1 hour, 24 hours, or the postoperative visit, and TNF was not reduced after surgery. Plasma choline increased only modestly, and there was no correlation between plasma choline and TNF concentrations (Pearson's correlation coefficient=20.17, P=0.22). Wound complications were not significantly different at 24 hours (2 of 29 vs 6 of 28; P=0.14), and all complications had resolved by the 2-week visit.
- Study & population
- Randomized placebo-controlled perioperative trial in adult women aged 18 to 60 years undergoing open gynecologic surgery (hysterectomy or myomectomy) at Columbia University Medical Center in New York, USA.
- Intervention
- Perioperative oral choline was given as a lecithin-derived supplement: 10 tablets containing 12 g high-choline lecithin and 4.2 g phosphatidylcholine the night before surgery with dinner, then a second dose as an oral gastric tube slurry after induction of general anesthesia.
- Key limitation
- The active arm was small (29 women) and the study was single-center, limiting generalizability.
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Open PDFOriginal abstract
BACKGROUND Activation of nicotinic receptors with nicotine has been shown to reduce post-surgical pain in clinical and preclinical studies. Choline is a selective agonist at α7-type nicotinic receptors that does not have addictive or sympathetic activating properties. It is anti-nociceptive in animal studies. We conducted a double-blind randomized trial of oral choline supplementation with lecithin to aid in the treatment of pain after gynaecological surgery. METHODS Sixty women having open gynaecological surgery were randomly assigned to receive 20 g of lecithin before surgery or placebo. Plasma choline concentration and tumour necrosis factor (TNF) were measured. Pain report was the primary outcome measure. RESULTS We achieved a small but statistically significant increase in choline after surgery with oral supplementation. Plasma TNF was not decreased and pain report was not different between groups at rest or with movement. There were no adverse effects of treatment. CONCLUSIONS Oral supplementation with lecithin during the perioperative period resulted in very slow absorption and thus only a small increase in plasma choline was achieved. This concentration was inadequate to reduce TNF as has been shown in other studies. The absence of an anti-inflammatory effect was likely related to our failure to demonstrate efficacy in pain reduction.