Postoperative Opiate Analgesia Requirements of Smokers

Nicotine’s pharmacologic actions affect numerous phys-iologic systems, including the peripheral nervous sys-tem, central nervous system (CNS), cardiovascular system, gastrointestinal tract, and exocrine glands. Nicotine marked-ly stimulates the CNS, with low doses producing weak analgesia and higher doses leading to tremors and seizures.1 The effect of nicotine on the perception of pain is of signif-icant clinical interest, particularly when considering that smokers abruptly discontinue their use of cigarettes on ad-mission to the hospital. In general, nicotine appears to blunt the perception of pain. This is supported by a study that demonstrated decreased sensitivity to heat stimulus af-ter nicotine was administered intranasally to both smokers and nonsmokers.2 In addition, administration of a nicotine patch decreased pain sensitivity to electrical shock irre-spective of smoking status.3 The mechanism of nicotine’s analgesic effect is not fully understood; however, a possi-ble explanation may be a rise in plasma β-endorphins, which has been shown to occur after smoking nicotine-containing cigarettes.4,5 While administration of nicotine appears to blunt nocicep-tive activity, one must also consider the pharmacologic ef-fects of withholding nicotine in hospitalized nicotine-depen-dent patients. In general, when nicotine is abruptly discontin-ued, nicotine-dependent patients demonstrate symptoms such as dysphoria, depressed mood, insomnia, irritability, frustration, anger, anxiety, difficulty concentrating, restless