Effect of nicotine dependence on opioid requirements of patients after thoracic surgery

This retrospective study investigated the effect of nicotine dependence on required postoperative opioid administration in patients undergoing thoracic surgery.

The subjects consisted of 215 male patients (112 nonsmokers, 103 smokers) who underwent thoracic surgery and received postoperative patient-controlled intravenous analgesia. Evaluations of nicotine dependence were based on results of Fagerstrom Test of Nicotine Dependence (FTND) questionnaires. Smokers were categorized as low-nicotine dependent (LD) (n = 58) or highly-nicotine dependent (HD, n = 45) with FTND scores < 6 or ≥ 6, respectively. Pain intensity was assessed every 2 h after surgery, using the numerical rating scale (NRS). The cumulative amount of self-administered sufentanil at 24 and 48 h after surgery was recorded.

There were no significant differences in baseline clinical characteristics among the nonsmoker (NS), LD, and HD groups. The NRS scores and total amount of self-administered sufentanil were significantly higher in the HD and LD groups compared with the NS group, and were significantly higher in the HD group than in the LD group. The FTND scores positively correlated with the cumulative quantity of sufentanil. Postoperative complications such as nausea and vomiting, sedation, and respiratory depression did not significantly differ among the groups.

Smokers had more severe postoperative pain and required a higher quantity of postoperative opioid than nonsmokers. With increasing nicotine dependence, postoperative pain severity and postoperative opioid requirement increased.