Abstract
Background
Although the need for increased postoperative analgesia in smokers has been described, the effect of secondhand smoke on postoperative analgesia requirements has not been studied. We examined the effects of secondhand smoke on fentanyl consumption and postoperative pain.
Methods
In this study, 101 patients (American Society of Anesthesiology physical status I and II) who underwent abdominal hysterectomy were divided into 3 groups according to history of exposure to cigarette smoke as per medical records which was retrospectively confirmed by measurement of serum cotinine: smokers (n = 28), nonsmokers (n = 31), and secondhand smokers (n = 32). All patients received propofol–remifentanil total intravenous anesthesia and used fentanyl patient controlled analgesia for postoperative pain. The fentanyl consumption visual analogue scale-pain intensity (VAS-PI) score and side effects were recorded in the postanesthesia care unit (PACU) and at 2, 4, 6, and 24 h after surgery.
Results
Fentanyl consumption at all the evaluation time points was significantly higher in secondhand smokers than in nonsmokers (P < 0.05). However, fentanyl consumption in secondhand smokers was lower than that in smokers in the PACU and at 24 h (P < 0.05). VAS-PI scores during movement and at rest in the PACU and at 4, 6, and 24 h after surgery were higher in secondhand smokers than in nonsmokers (P < 0.05). There were no statistically significant differences between the groups with regard to side effects such as nausea, vomiting, and dizziness (P > 0.05).
Conclusion
Secondhand smoking was associated with increased postoperative fentanyl consumption, and increased VAS-PI scores. These findings may be beneficial for managing postoperative pain in secondhand smokers.
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References
Pavlin JD, Kent CD. Recovery after ambulatory anesthesia. Curr Opin Anaesthesiol. 2008;21:729–35.
Yanagidate F, Dohi S. Epidural oxycodone or morphine following gynaecological surgery. Br J Anaesth. 2004;93:362–7.
Tønnesen H. Surgery and smoking at first and second hand: time to act. Anesthesiology. 2011;115:1–3.
Creekmore FM, Lugo RA, Weiland KJ. Postoperative opiate analgesia requirements of smokers and nonsmokers. Ann Pharmacother. 2004;38:949–53.
Woodside JR Jr. Female smokers have increased postoperative narcotic requirements. J Addict Dis. 2000;19:1–10.
Centers for Disease Control and Prevention (CDC). Disparities in secondhand smoke exposure—United States, 1988–1994 and 1999–2004. MMWR Morb Mortal Wkly Rep. 2008;57:744–7.
Apfel CC, Roewer N, Korttila K. How to study postoperative nausea and vomiting. Acta Anaesthesiol Scand. 2002;46:921–8.
Patrick DL, Cheadle A, Thompson DC, Diehr P, Koepsell T, Kinne S. The validity of self-reported smoking: a review and meta-analysis. Am J Public Health. 1994;84:1086.
Seccareccia F, Zuccaro P, Pacifici R, Meli P, Pannozzo F, Freeman KM, Santaquilani A, Giampaoli S; Research Group of the MATISS Project. Serum cotinine as a marker of environmental tobacco smoke exposure in epidemiological studies: the experience of the MATISS project. Eur J Epidemiol. 2003;18(6):487–92.
Benowitz NL, Kuyt F, Jacob P III, Jones RT, Osman AL. Cotinine disposition and effects. Clin Pharmacol Ther. 1983;34:604.
Lee PN. Misclassification as a factor in passive smoking risk. Lancet. 1986;2:867.
Wagenknecht LE, Burke GL, Perkins LL, Haley NJ, Friedman GD. Misclassification of smoking status in the CARDIA study: a comparison of self-report with serum cotinine levels. Am J Public Health. 1992;82:33.
Jarvis MJ, Russell MA. Measurement and estimation of smoke dosage to non-smokers from environmental tobacco smoke. Eur J Respir Dis Suppl. 1984;133:68.
Hintze J. Power analysis and sample size. NCSS, LLC: Kaysville, Utah; 2008. http//www.ncss.com. Accessed 1st May 2011.
Steinmiller CL, Diederichs C, Roehrs TA, Hyde-Nolan M, Roth T, Greenwald MK. Postsurgical patient-controlled opioid self-administration is greater in hospitalized abstinent smokers than nonsmokers. J Opioid Manag. 2012;8(4):227–35.
Creekmore FM, Lugo RA, Weiland KJ. Postoperative opiate analgesia requirements of smokers and nonsmokers. Ann Pharmacother. 2004;38:949–53.
Woodside JR Jr. Female smokers have increased postoperative narcotic requirements. J Addict Dis. 2000;19:1–10.
Stanley TH, DeLang S. The effect of population habits on side effects and narcotic requirements during high dose fentanyl anaesthesia. Can Anaesth Soc J. 1984;31:368–76.
Macintyre PE, Jarvis DA. Age is the best predictor of postoperative morphine requirements. Pain. 1996;64:357–64.
Morin C, Lund JP, Villarroel T, Clokie CM, Feine JS. Differences between the sexes in post-surgical pain. Pain. 2000;85:79–85.
Shi Y, Weingarten TN, Mantilla CB, Hooten WM, Warner DO. Smoking and pain: pathophysiology and clinical implications. Anesthesiology. 2010;113:977–92.
Schein JR. Cigarette smoking and clinically significant drug interactions. Ann Pharmacother. 1995;29:1139–48.
Sivam SP, Ho IK. Analgesic cross-tolerance between morphine and opioid peptides. Psychopharmacol (Berl). 1984;84:64–5.
Pomerleau OF, Fertig JB, Seyler LE, Jaffe J. Neuroendocrine reactivity to nicotine in smokers. Psychopharmacol (Berl). 1983;81:61–7.
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The authors received no financial support. The authors have indicated that they have no conflicts of interest regarding the content of this article.
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Aydogan, M.S., Ozturk, E., Erdogan, M.A. et al. The effects of secondhand smoke on postoperative pain and fentanyl consumption. J Anesth 27, 569–574 (2013). https://doi.org/10.1007/s00540-013-1565-0
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DOI: https://doi.org/10.1007/s00540-013-1565-0