Smokers Experience More Postoperative Pain Than Nonsmokers

A new study has found that smokers experience more pain and are more likely to suffer from severe pain following ambulatory surgery.

Researchers at The Cleveland Clinic (OH, USA) and other institutions collected data from 2,157 adults who underwent elective ambulatory surgery under general anesthesia (GA); the average age of the participants was 49.5 years, 64.6% were female, average body mass index (BMI) was 28.3, and 15.2% were smokers. The procedures took place in 12 hospitals across the United States, and the researchers collected pre-, intra-, and postoperative data. The primary end point was severe acute postoperative pain (over 7 on a scale of 1-10), which could be reported any time after the cessation of anesthesia until 48 hours after hospital discharge.

The results showed that 24.5% of all patients reported severe postoperative pain while in the postanesthesia care unit (PACU), and 33.6% reported severe postoperative pain by 48 hours after hospital discharge. In the PACU, 22% of the nonsmokers and 38.5% of the smokers reported severe pain; by 48 hours post-discharge, the rate was 54.1% among smokers and 29.9% among nonsmokers. Current smoking status was an independent predictor of a heightened risk for severe postoperative pain in the PACU; other independent predictors of severe postoperative pain included being younger than 40 years of age, having a BMI above 30, having a preoperative anticipation of postoperative pain of 4 or higher, and undergoing surgery that takes longer than one hour. The study was presented at the American Society of Anesthesiologists annual meeting, held during October 2010 in San Diego (CA, USA).

"It is critical for physicians to acknowledge smoking status during preoperative evaluation, particularly when strategizing about how to best apply prophylaxis and analgesic therapies for postoperative and posthospital-discharge pain management,” said study presenter and coauthor Alparslan Turan, M.D., an associate professor of anesthesia at The Cleveland Clinic.

The implications of cigarette smoking to the practice of anesthesiology and pain medicine are complex and not well understood. Cigarette smoke contains thousands of compounds, with many of them producing significant physiologic effects.

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