慢性吸烟与肺癌或食管癌患者术后阿片类药物使用增加无关。

Chronic Smoking is Not Associated with Increased Postoperative Opioid Use in Patients with Lung Cancer or Esophageal Cancer.

机构信息

Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Gumi-ro, Bundang-gu, Seongnam, Korea.

Department of Thoracic Surgery, National Cancer Center, Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, Republic of Korea.

出版信息

Pain Physician. 2018 Jan;21(1):E49-E55.

PMID:29357340

Abstract

BACKGROUND

Chronic smokers show differences in pain sensitivity compared to healthy non-smokers. Yet, no study to date has examined whether smoker status has an effect on postoperative pain.

OBJECTIVE

We aim to examine a possible correlation between preoperative smoking and postoperative opioid dose based on the hypothesis that smokers would use higher doses of opioids to manage increased postoperative pain.

STUDY DESIGN

A retrospective observational cohort study.

SETTING

The National Cancer Center in Korea.

METHODS

We examined medical record data for patients who had undergone curative resection for either lung or esophageal cancer (lobectomy or bilobectomy for lung cancer or an Ivor Lewis operation for esophageal cancer) between January 1, 2006 and December 31, 2010. We examined the correlation between the total preoperative average number of packs per day multiplied by years of cigarette smoking (pack-years) and morphine equivalent daily doses administered to patients after surgery, considering each type of cancer both individually and together. Partial correlation and regression analyses were performed to determine the causality of a possible relationship between pack-years of cigarette smoking and postoperative opioid dose.

RESULTS

A total of 1,129 patients (871 patients with lung cancer and 258 patients with esophageal cancer) were included in the final analysis. There was no significant correlation between total pack-years of cigarette smoking and postoperative opioid dose for lung cancer, esophageal cancer, or both cancer types combined (r = 0.042, -0.012, and 0.037, respectively). In the analysis of both cancer types combined, video-assisted thoracic surgery (VATS) was associated with an 11.1% decrease in opioid dose (β = -0.111, P = 0.003) and epidural analgesia was associated with a 7.2% increase in opioid dose (β = 0.072, P = 0.042).

LIMITATIONS

The retrospective design of this study is a limitation.

CONCLUSION

Our study did not observe a correlation between preoperative smoking and postoperative opioid dose in patients with lung or esophageal cancer.

KEY WORDS

Smoking, postoperative pain, opioid, lung cancer, esophageal cancer, analgesia.

摘要

背景

与健康的非吸烟者相比，慢性吸烟者的疼痛敏感性存在差异。然而，迄今为止尚无研究探讨吸烟状况是否会影响术后疼痛。

目的

我们旨在根据以下假设检验术前吸烟与术后阿片类药物剂量之间是否存在相关性，即吸烟者将使用更高剂量的阿片类药物来控制增加的术后疼痛。

研究设计

回顾性观察队列研究。

地点

韩国国家癌症中心。

方法

我们检查了 2006 年 1 月 1 日至 2010 年 12 月 31 日期间接受肺癌或食管癌根治性切除术的患者（肺癌行肺叶切除术或双肺叶切除术，食管癌行 Ivor Lewis 手术）的病历数据。我们分别考虑每一种癌症类型，以及两种癌症类型同时考虑，检验术前平均每天吸烟包数乘以吸烟年数（吸烟包年）与术后患者给予的吗啡等效日剂量之间的相关性。进行偏相关和回归分析以确定吸烟与术后阿片类药物剂量之间可能存在的关系的因果关系。

结果

共有 1129 例患者（871 例肺癌患者和 258 例食管癌患者）纳入最终分析。肺癌、食管癌或两种癌症类型的总吸烟包年与术后阿片类药物剂量之间无显著相关性（r = 0.042、-0.012 和 0.037）。在两种癌症类型联合分析中，电视辅助胸腔镜手术（VATS）与阿片类药物剂量减少 11.1%相关（β = -0.111，P = 0.003），硬膜外镇痛与阿片类药物剂量增加 7.2%相关（β = 0.072，P = 0.042）。