Smoking and Postoperative Pain: A Systematic Review and Meta-Analysis

Smoking is known to increase the risk of numerous postoperative complications, including increased rates of infection, cardiovascular events, and pulmonary complications. In addition, there may be an effect of smoking on pain in the perioperative period. Through this meta-analysis, we sought to investigate what is known about the relationship between smoking and acute postoperative pain.

Articles published between January 2003 and December 2023 that compared smokers to nonsmokers and utilized pain scores and/or measured postoperative opioid consumption were selected for review. 95% confidence intervals were utilized to determine statistical significance in standardized mean differences for each outcome between smokers and nonsmokers.

The meta-analysis included five studies that assessed postoperative pain scores and opioid requirements in smokers and nonsmokers. In the analysis of pain scores, smokers consistently had higher pain scores overall on all postoperative days (POD) 0 (0.46 [95% CI: 0.26-0.66]), POD1 (0.32 [0.17-0.46]), and POD2 (0.38 [0.24-0.52]). Smokers also demonstrated higher opioid requirements compared to nonsmokers on POD0 (0.62 [0.43-0.80]), POD1 (0.49 [0.36-0.62]), and POD2 (0.70 [0.56-0.84]). Four additional studies were included in our systematic review, which further revealed an association between smoking history and postoperative pain.

Smokers demonstrate increased postoperative pain, as assessed by pain scores and opioid requirements. The ability to anticipate increased postoperative pain in this population has the potential to improve postoperative outcomes for patients with a smoking history.