Nicotine smoking: Influences on perioperative pain management

Background: The complex relationship between smoking and pain has clinical relevance in the practice of anesthesiology and pain medicine. The present study investigated the effect of heavy nicotine smoking on perioperative pain management. Methods: This prospective controlled study was carried out in Alexandria Main University hospital on 80 adult ASA I and II patients scheduled for lower limb fractures fixation under general anesthesia after an informed written consent and approval of the Medical Ethics Committee. Patients were divided into 2 groups: group N included nonsmokers and group S included the heavy smokers. Intraoperative heart rate (HR), mean arterial blood pressure (MAP) and intraoperative analgesia were recorded. Postoperatively; HR, MAP, pain visual analog scale (VAS) and total postoperative analgesic requirements were recorded. Results: Intraoperative and postoperative HR and MAP showed significantly higher values in group S patients than group N patients. VAS values were significantly lower in group N than group S at recovery, 8 and 24 h postoperatively. Total intraoperative and postoperative analgesic requirements of meperidine were significantly lower in group N than group S. Conclusions: Chronic nicotine smoking increases the incidence of perioperative pain. Heavy smokers need more perioperative analgesia than nonsmokers