Steinmiller Caren L, Diederichs Christina, Roehrs Timothy A, Hyde-Nolan Maren, Roth Thomas, Greenwald Mark K
Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, Michigan, USA.
J Opioid Manag. 2012 Jul-Aug;8(4):227-35. doi: 10.5055/jom.2012.0120.
To compare 24-hour postsurgical patient-controlled analgesia (PCA) in smokers and nonsmokers.
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).
Patients resided in the Orthopedic Unit at Henry Ford Hospital for the duration of the study.
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).
Postsurgical analgesic medication requests and denials were the primary measures.
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.
These data suggest that acute nicotine abstinence during hospitalization increases PCA opioid medication seeking but not consumption during postoperative recovery.
比较吸烟者和非吸烟者术后24小时的患者自控镇痛（PCA）情况。
患者完成一份术前问卷，询问睡眠、尼古丁及其他物质使用情况和共病情况。手术当天入院时停止使用尼古丁。上午手术后且（脊髓）麻醉恢复后，每位患者开始使用一种限制剂量频率（吗啡1毫克等效单位）并设置锁定期（范围为6 - 10分钟）的装置进行阿片类药物PCA。
在研究期间，患者居住在亨利·福特医院的骨科病房。
完成术前问卷的吸烟者（n = 13）和健康非吸烟者（n = 13），根据年龄、性别和手术类型（髋关节置换术与膝关节置换术）进行匹配。
术后镇痛药物的请求和拒绝情况是主要指标。
除了组间匹配变量外，吸烟者（自我报告每天吸食2 - 30支香烟[平均11.7支]）和非吸烟者在平均体重、身高、体重指数、手术开始时间（约上午9:45）、PCA开始时间（约下午4点）或锁定间隔（8.6分钟）方面无显著差异。在PCA之前的恢复期间，接受阿片类药物的吸烟者（n = 11）比非吸烟者（n = 5）更多（x² = 5.85，p > 0.05）。在PCA期间，吸烟者比非吸烟者有更多的注射被拒情况[F(1,24) = 4.65，p > 0.05]，每次请求的输注次数更少[F(1,24) = 6.74，p > 0.05]。在夜间，吸烟者比非吸烟者有更多的输注请求[F(1,24) = 4.41，p > 0.05]和更多的注射被拒情况[F(1,24) = 5.67，p > 0.03]。
这些数据表明，住院期间急性戒烟会增加PCA阿片类药物的寻求，但在术后恢复期间不会增加其消耗量。
