Cigarette smoking, opioid consumption, and pain intensity after major surgery: An observational study

Yi Chien Wang, Chien Wun Wang, Hsiang Ling Wu, Juan P. Cata, Shih Yu Huang, Yu Ming Wu, Jui Tai Chen, Yih Giun Cherng, Ying Hsuan Tai

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)


Background: Chronic exposure to nicotine may change pain perception and promote opioid intake. This study aimed to evaluate the putative effect of cigarette smoking on opioid requirements and pain intensity after surgery. Methods: Patients who underwent major surgery and received intravenous patient-controlled analgesia (IV-PCA) at a medical center between January 2020 and March 2022 were enrolled. Patients' preoperative smoking status was assessed using a questionnaire by certified nurse anesthetists. The primary outcome was postoperative opioid consumption within 3 days after surgery. The secondary outcome was the mean daily maximum pain score, assessed using a self-report 11-point numeric rating scale, and the number of IV-PCA infusion requests within three postoperative days. Multivariable linear regression models were used to calculate the regression coefficient (beta) and 95% confidence interval (CI) for the association between smoking status and outcomes of interest. Results: A total of 1162 consecutive patients were categorized into never smokers (n = 968), former smokers (n = 45), and current smokers (n = 149). Current smoking was significantly associated with greater postoperative opioid consumption (beta: 0.296; 95% CI, 0.068-0.523), higher pain scores (beta: 0.087; 95% CI, 0.009-0.166), and more infusion requests (beta: 0.391; 95% CI, 0.073-0.710) compared with never smokers. In a dose-dependent manner, smoking quantity (cigarette per day) was positively correlated with both intraoperative (Spearman's rho: 0.2207, p = 0.007) and postoperative opioid consumption (Spearman's rho: 0.1745, p = 0.033) among current smokers. Conclusion: Current cigarette smokers experienced higher acute pain, had more IV-PCA infusion requests, and consumed more opioids after surgery. Multimodal analgesia with nonopioid analgesics and opioid-sparing techniques, along with smoking cessation should be considered for this population.

Original languageEnglish
Pages (from-to)440-448
Number of pages9
JournalJournal of the Chinese Medical Association
Issue number4
Publication statusPublished - Apr 2023


  • Narcotic
  • Nicotine
  • Pain sensitivity
  • Postoperative pain

ASJC Scopus subject areas

  • General Medicine


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