The effects of nicotine dependence on postoperative opioid requirements

Objective To investigate the effect of nicotine dependence on postoperative opioid requirement in patients undergoing thoracic surgery.Methods Two hundred and fifteen male patients (112 nonsmokers and 103 smokers) undergoing thoracic surgery were retrospectively analyzed.All patients received postoperative patient-controlled intravenous analgesia(PCIA) after surgery.Nicotine dependence was evaluated according to the Fagerstrom test of nicotine dependence (FTND) questionnaires.Smokers were categorized into two groups:the low-dependent group(MD group) with FTND scores ＜6(n=58) and high-dependent group (HD group) with FTND scores ≥ 6 (n=45).Pain intensity was evaluated every 2 h after surgery,using the numerical rating scale (NRS).The subtotal amount of sufentanil administered thru PCIA at 24 h and 48 h after surgery were recorded.Results There were no significant differences in baseline clinical characteristics and total fentanyl usage intraoperatively among the nonsmoker (NS),MD,and HD groups.The NRS scores were significantly higher in the HD and MD groups compared with the NS group,and were higher in the HD group than in the MD group.The total dosage of sufentanil at 24 and 48 h after surgery in the HD group were (116±45),(227±78) ag respectively,which were (77±37),(164±77) μg in the MD group,and (60±34),(122±66) μg in the NS group.The total dosage of sufentanil were higher in the HD and MD groups compared with the NS group (P＜0.05),and were higher in the HD group than in the MD group (P＜0.05).The FTND scores were positively correlated with the accumulated dosage of sufentanil in the 24 h(r=0.370) and 48 h(r=0.441) after surgery.The incidence of postoperative nausea and vomiting in the HD group were 6.6％ and 2.2％ respectively,which were 6.9％,3.4％ in MD group,and 7.1％ and 3.6％ in the NS group.There were no significant difference among the three groups (P＞0.05).None of all the patients had developed excessive sedation or respiratory depression.Conclusions Smokers have more severe postoperative pain and higher postoperative opioid requirement than nonsmokers.With increasing nicotine dependence,postoperative pain severity and postoperative opioid requirement increase. Key words: Nicodine dependence;  Smoking;  Postoperative analgesia;  Patient controlled intravenous analgesia; Sufentanil