Postsurgical patient-controlled opioid self-administration is greater in hospitalized abstinent smokers than nonsmokers.

OBJECTIVE

To compare 24-hour postsurgical patient-controlled analgesia (PCA) in smokers and nonsmokers.

DESIGN

Patients completed a presurgical questionnaire inquiring about sleep, nicotine and other substance use, and comorbid disorders. Nicotine use was discontinued on hospital admission on the day of surgery. After morning surgery and (spinal) anesthesia recovery, each patient began opioid PCA with a device that limited dose frequency (morphine 1 mg equivalent units) using a lockout period (range, 6-10 minutes).

SETTING

Patients resided in the Orthopedic Unit at Henry Ford Hospital for the duration of the study.

PATIENTS

Cigarette smokers (n 5 13) and healthy nonsmokers (n 5 13) who completed the presurgical questionnaire were matched for age, gender, and type of surgery (hip vs knee replacement).

MAIN OUTCOME MEASURES

Postsurgical analgesic medication requests and denials were the primary measures.

RESULTS

In addition to group-matching variables, smokers (self-report of consuming 2-30 cigarettes per day [mean, 11.7]) and nonsmokers did not significantly differ in average weight, height, body mass index, surgery start time (about 9:45 AM), PCA start time (about 4 PM), or lockout interval (8.6 minutes). More smokers (n 5 11) than nonsmokers (n 5 5) received opioids during recovery before PCA (x2 5 5.85, p > 0.05). During PCA, smokers had significantly more injection denials [F(1,24) 5 4.65, p > 0.05] and fewer infusions per request [F(1,24) 5 6.74, p > 0.05] than nonsmokers. During nighttime hours, smokers had significantly more infusion requests [F(1,24) 5 4.41, p > 0.05] and more injection denials [F(1,24) 5 5.67, p > 0.03] than nonsmokers.

CONCLUSIONS

These data suggest that acute nicotine abstinence during hospitalization increases PCA opioid medication seeking but not consumption during postoperative recovery.