Effects of smoking on postoperative pain and opioid consumption in patients with major abdominal oncological surgery

Aims: Major abdominal oncologic surgeries cause serious postoperative pain because they contain extensive tissue damage and large skin incision. Therefore, major abdominal oncological surgeries require more opioid consumption. In addition, there is an association between smoking and opioid use. The objective of this study is to evaluate the potential relationships between smoking status and postoperative pain and opioid analgesic consumption in patients after major abdominal oncological surgery. Methods: For the study, the approval was obtained from the Ethics Committee of our instution. 130 patients between 18-75 years of age who underwent elective major abdominal oncological surgery under general anesthesia, had ASA I-III score and was planned for intravenous morphine-controlled analgesia for postoperative analgesia were included in the study. The patients were divided into two groups as smoking (65 patients) and non-smoking (65 patients). ASA scores, age, gender, height, weight, and additional diseases were recorded. Fagerström Test for Nicotine Dependence was applied to patients who had been smoking for at least 1 year. In the postoperative care unit, heart rate, blood pressure, Sp02, values, blood pressure values, Ramsey sedation scores were recorded at 0 hours, 2 hours, 6 hours, 12 hours, 24 hours and 48 hours. At these measurement times, the pain intensity of the patients was evaluated by a visual pain scale. Patients' additional analgesic requirement, total morphine consumption, demand from patient-controlled analgesia device, nausea-vomiting, itching, gas release times, hypotension and dry mouth were recorded. Results: In this study, postoperative 0 hour, 2nd hour, 6th hour, 12th hour, 24th hour and 48th hour VAS scores and the amount of morphine consumed were significantly higher in the smokers compared to non-smokers. In terms of additional analgesic use, it was found that the use of additional analgesics was significantly higher in the group of smokers. Dry mouth and the incidence of nausea/vomiting were significantly higher in smoking patients than in non-smoking patients. Conclusion: It has been found that smoking increases the severity of postoperative pain in patients who underwent major abdominal cancer surgery and these patients need more opioids. We are of the view that while planning postoperative analgesia, effective treatment strategies can be determined by considering that there may be more severe pain in smoking patients.