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PAIN MANAGEMENT

Postoperative Opiate Analgesia Requirements of Smokers and Nonsmokers

Assistant Professor of Pharmacy Practice, College of Pharmacy, University of Utah, Salt Lake City, UT

Ralph A Lugo, PharmD

Associate Professor of Pharmacy Practice, College of Pharmacy, University of Utah

Kevin J Weiland, MD

Assistant Professor of Internal Medicine, School of Medicine, University of South Dakota, Vermillion, SD

Reprints: Freddy M Creekmore PharmD, College of Pharmacy, University of Utah, 30 S. 2000 East, Rm 258, Salt Lake City, UT 84112-5820, fax 801/585-6160, fcreekmore{at}pharm.utah.edu

BACKGROUND: Smoking cigarettes and other forms of nicotine administration appear to blunt the perception of pain. Abrupt discontinuation of nicotine in nicotine-dependent patients appears to increase the perception of pain. The clinical importance of nicotine's effect on pain perception is not fully understood.

OBJECTIVE: To determine whether smokers who abruptly discontinue smoking as a result of being hospitalized for coronary artery bypass graft (CABG) require more postoperative opiate analgesics than nonsmokers.

METHODS: A retrospective review of patients who underwent a CABG was performed. Smokers (n = 20) were compared with nonsmokers (n = 69) with regard to opiate analgesic use during the first 48 hours postoperatively. The use of nonopiate sedatives was also compared between the groups.

RESULTS: When normalized for weight and body mass index, smokers required 23% and 33%, respectively, more opiate analgesics than did nonsmokers (p = 0.027 and 0.023, respectively). The percentage of patients who received benzodiazepines postoperatively was similar in the 2 groups.

CONCLUSIONS: In this study, smokers deprived of nicotine required a greater amount of opiates in the first 48 hours after CABG than did nonsmokers. Healthcare providers need to be aware of the potential for increased narcotic requirements among nicotine-deprived smokers. Further study is needed to determine whether nicotine replacement lessens the requirement for postoperative analgesics in smokers.

Key Words: nicotine, opioid analgesics, postoperative pain, smoking

Published Online, April 27, 2004. www.theannals.com, DOI 10.1345/aph.1D580

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