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Senior Registrar Department of Anesthesiology Vakif Gureba Hospital Istanbul, Turkey
Senior Registrar Department of AnesthesiologyVakif Gureba HospitalSoganli Mah. Alper Sok. Yuvam Apt.No=1/20 Bahcelievler, Istanbul 34590, Turkeyfax 90 212 621 7580 gbasaranoglu{at}hotmail.com
Senior Registrar Department of Anesthesiology Vakif Gureba Hospital
Senior Registrar Department of Anesthesiology Vakif Gureba Hospital
Chief Department of Anesthesiology Vakif Gureba Hospital
Published Online, August 2, 2005. www.theannals.com, DOI 10.1345/aph.1G157
Methods. After obtaining approval of the local ethics committee and written informed consent from 60 unpremedicated patients (ASA physical status I-II, 30 smokers, 30 nonsmokers) undergoing elective total abdominal hysterectomy with salpingo-oopherectomy were studied. The duration of smoking ± SD was 19.3 ± 6.4 years, and the number of cigarettes smoked per day was 15.2 ± 8.1. All patients were given a standard anesthetic. All patients received patient-controlled analgesia (PCA) with meperidine, with a 50-mg loading dose, 1-mg h-1 basal infusion dose, and a 5-mg incremental dose, with a 15-minute lockout interval.
Patients were evaluated at 1, 2, 6, 12, 18, and 24 hours for numerical rating scores (NRS; 0 = no pain; 10 = excruciating pain), sedation, subjective analgesic efficacy, and meperidine consumption. Patients with inadequate analgesia during the 24-hour assessment period were administered intramuscular diclofenac sodium 50 mg (NRS remained >5 despite PCA meperidine, and pts. asked for an additional analgesic). There were no significant differences between the 2 groups in age and weight (Table 1).
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Results. The NRS at 1, 2, and 6 hours were significantly higher in the smokers compared with the nonsmokers (Table 1). Subjective assessment of analgesic efficacy and 24-hour meperidine consumption are shown in Table 1. One patient in the nonsmokers group and 10 patients in the smokers group were administered diclofenac sodium because of inadequate analgesia. Inadequate analgesia was significantly higher in smokers (p = 0.006). Sedation scores and the duration of surgery were similar between groups.
Discussion. Nicotine is a psychostimulant that affects both cortical and autonomic arousal. Thus, it could affect the manner in which the brain processes sensory stimuli and the central perception of pain. Tobacco might cause general damage to musculoskeletal tissues through vasoconstriction, hypoxia, and defective fibrinolysis. Current and exsmokers more often report tiredness, stress, and headaches, which could indicate a lower threshold for reporting symptoms in general.2 Studies in both smoking and nonsmoking volunteers have shown that nicotine has either increased or decreased the tolerance of controlled painful stimulus.3 The longer the smokers had been deprived of cigarettes, the longer before the onset of ischemic pain. Treatment with a single dose of nicotine immediately before patients' emergence from anesthesia was associated with lower pain scores during the first day after surgery in nonsmokers.4 In this study, PCA meperidine settings may have been too low since the smokers could not receive enough meperidine to lower their pain scores to the same level as the nonsmokers. However, patients who smoked had worse pain scores with the same meperidine doses.
In conclusion, we observed a relationship between smoking and postoperative pain associated with a decrease in analgesic efficacy in smokers.
References
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