Wang Yi-Chien, Wang Chien-Wun, Wu Hsiang-Ling, Cata Juan P, Huang Shih-Yu, Wu Yu-Ming, Chen Jui-Tai, Cherng Yih-Giun, Tai Ying-Hsuan
Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan, ROC.
Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC.
J Chin Med Assoc. 2023 Apr 1;86(4):440-448. doi: 10.1097/JCMA.0000000000000895. Epub 2023 Mar 13.
Chronic exposure to nicotine may change pain perception and promote opioid intake. This study aimed to evaluate the putative effect of cigarette smoking on opioid requirements and pain intensity after surgery.
Patients who underwent major surgery and received intravenous patient-controlled analgesia (IV-PCA) at a medical center between January 2020 and March 2022 were enrolled. Patients' preoperative smoking status was assessed using a questionnaire by certified nurse anesthetists. The primary outcome was postoperative opioid consumption within 3 days after surgery. The secondary outcome was the mean daily maximum pain score, assessed using a self-report 11-point numeric rating scale, and the number of IV-PCA infusion requests within three postoperative days. Multivariable linear regression models were used to calculate the regression coefficient (beta) and 95% confidence interval (CI) for the association between smoking status and outcomes of interest.
A total of 1162 consecutive patients were categorized into never smokers (n = 968), former smokers (n = 45), and current smokers (n = 149). Current smoking was significantly associated with greater postoperative opioid consumption (beta: 0.296; 95% CI, 0.068-0.523), higher pain scores (beta: 0.087; 95% CI, 0.009-0.166), and more infusion requests (beta: 0.391; 95% CI, 0.073-0.710) compared with never smokers. In a dose-dependent manner, smoking quantity (cigarette per day) was positively correlated with both intraoperative (Spearman's rho: 0.2207, p = 0.007) and postoperative opioid consumption (Spearman's rho: 0.1745, p = 0.033) among current smokers.
Current cigarette smokers experienced higher acute pain, had more IV-PCA infusion requests, and consumed more opioids after surgery. Multimodal analgesia with nonopioid analgesics and opioid-sparing techniques, along with smoking cessation should be considered for this population.
长期接触尼古丁可能会改变疼痛感知并增加阿片类药物的摄入量。本研究旨在评估吸烟对手术后阿片类药物需求量和疼痛强度的假定影响。
纳入2020年1月至2022年3月期间在一家医疗中心接受大手术并接受静脉自控镇痛（IV-PCA）的患者。由认证护士麻醉师通过问卷评估患者术前的吸烟状况。主要结局是术后3天内的阿片类药物消耗量。次要结局是使用自我报告的11点数字评分量表评估的每日平均最大疼痛评分，以及术后3天内IV-PCA输注请求的次数。使用多变量线性回归模型计算吸烟状况与感兴趣结局之间关联的回归系数（β）和95%置信区间（CI）。
总共1162例连续患者被分为从不吸烟者（n = 968）、既往吸烟者（n = 45）和当前吸烟者（n = 149）。与从不吸烟者相比，当前吸烟与术后更高的阿片类药物消耗量（β：0.296；95%CI，0.068 - 0.523）、更高的疼痛评分（β：0.087；95%CI，0.009 - 0.166）以及更多的输注请求（β：0.391；95%CI，0.073 - 0.710）显著相关。在当前吸烟者中，吸烟量（每天的香烟数）与术中（Spearman相关系数：0.2207，p = 0.007）和术后阿片类药物消耗量（Spearman相关系数：0.1745，p = 0.033）均呈剂量依赖性正相关。
当前吸烟者术后经历更高的急性疼痛，有更多的IV-PCA输注请求，并且消耗更多的阿片类药物。对于该人群，应考虑采用非阿片类镇痛药和阿片类药物节省技术的多模式镇痛以及戒烟。
