title: Postoperative opiate analgesia requirements of smokers and nonsmokers.
abstract: BACKGROUND
  Smoking cigarettes and other forms of nicotine administration appear to blunt the perception of pain. Abrupt discontinuation of nicotine in nicotine-dependent patients appears to increase the perception of pain. The clinical importance of nicotine's effect on pain perception is not fully understood.
  
  
  OBJECTIVE
  To determine whether smokers who abruptly discontinue smoking as a result of being hospitalized for coronary artery bypass graft (CABG) require more postoperative opiate analgesics than nonsmokers.
  
  
  METHODS
  A retrospective review of patients who underwent a CABG was performed. Smokers (n = 20) were compared with nonsmokers (n = 69) with regard to opiate analgesic use during the first 48 hours postoperatively. The use of nonopiate sedatives was also compared between the groups.
  
  
  RESULTS
  When normalized for weight and body mass index, smokers required 23% and 33%, respectively, more opiate analgesics than did nonsmokers (p = 0.027 and 0.023, respectively). The percentage of patients who received benzodiazepines postoperatively was similar in the 2 groups.
  
  
  CONCLUSIONS
  In this study, smokers deprived of nicotine required a greater amount of opiates in the first 48 hours after CABG than did nonsmokers. Healthcare providers need to be aware of the potential for increased narcotic requirements among nicotine-deprived smokers. Further study is needed to determine whether nicotine replacement lessens the requirement for postoperative analgesics in smokers.
authors.affiliation: College of Pharmacy, University of Utah, 30 S. 2000 East, Room 258, Salt Lake City, UT 84112-5820, USA. fcreekmore@pharm.utah.edu
authors.forename: Freddy M
authors.initials: FM
authors.lastname: Creekmore
authors.forename: Ralph A
authors.initials: RA
authors.lastname: Lugo
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Weiland
mesh_terms: D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000627:therapeutic use*; D001569:Benzodiazepines / Q000008:administration & dosage / Q000627:therapeutic use; D001026:Coronary Artery Bypass / Q000009:adverse effects; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000188:drug therapy* / Q000209:etiology; D012189:Retrospective Studies; D013375:Substance Withdrawal Syndrome / Q000188:drug therapy / Q000209:etiology; D014029:Tobacco Use Disorder / Q000150:complications*
chemical_list: D000701:Analgesics, Opioid; D001569:Benzodiazepines