The Implications of Tobacco Smoking on Acute Postoperative Pain: A Prospective Observational Study

Abstract

Background. The clinical importance of cigarette smoking on acute postoperative pain perception is not fully understood. Methods. To determine whether smokers who underwent major surgery need more postoperative opiate than do nonsmokers. We prospectively enrolled 407 male and 441 female participants who underwent in-hospital surgery. Current-smokers were compared with nonsmokers and past-smokers about opiate use during the first 72 h after surgery. Results. A greater proportion of males had more smoking history than females. The average age of male current-smokers is smaller than both nonsmokers and past-smokers. The surgical type (upper abdomen, lower abdomen, extremities, spine, and others) and duration of surgery have no differences between current-smokers, past-smokers, and nonsmokers. Statistically, the male current-smokers required more opiate analgesics during the first 72 h following surgery compared with the male nonsmokers and past-smokers; furthermore, the male current-smokers reported higher pain intensity when moving and at rest on day 1 after surgery. Conclusions. In this study, the male current-smokers required more morphine in the first 72 h after surgery than did the nonsmokers and past-smokers. Furthermore, smoking was more prevalent among the males than the females. Health care providers must be aware of the potential for increased narcotic requirements in male current-smokers.

Risk factors associated with postoperative pain and discomfort in oculoplastic surgery with general anesthesia: a prospective study

“…One study revealed that current smokers required more morphine than non-smokers and past smokers during the 72 hours after other types of surgery. 12 However, the potential mechanisms of the interaction between smoking and acute postoperative pain are complex and not fully understood. 13 …”

Development and implementation of a comprehensive spine surgery enhanced recovery after surgery protocol: the Cleveland Clinic experience

“…They found that male current smokers required more opioid analgesia during the first 72 hours after surgery than the other 2 groups. 9 In addition, they also reported higher pain intensity scores on postoperative day (POD) 1. Patients undergoing elective fusion surgery are required to cease nicotine use prior to scheduling surgery.…”

Consensus Statement for the Prescription of Pain Medication at Discharge after Elective Adult Surgery

“…A common finding in the literature is that current and previous tobacco use is associated with the risk of intense acute pain and persistent opioid use. 25,26 Smoking may be an important modifiable risk factor for pain intensity and opioid use after surgery. 27 The Opioid Risk Tool, which can be easily sourced on the Internet, 28 is a questionnaire that is usually used to assess an adult's propensity to develop an opioid use disorder in the setting of chronic pain.…”