The implications of tobacco smoking on acute postoperative pain: a prospective observational study

Nicotine has been known to invigorate the central nervous system (CNS) and lead to analgesia at low doses. This Asian population based study showed that men still smoke at eminent rates, thus allowing for better comparisons to be made between smokers and nonsmokers in regard to acute postoperative pain. Total morphine requirement differences between different groups was observed by adjusting age, weight and surgical duration.

The clinical importance of cigarette smoking on acute postoperative pain perception is not fully understood.

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.

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. 

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.