Enviromental smoking and postoperative analgesia requirement

Environmental smoking and postoperative analgesia requirementIntroduction: Postoperative pain is one of the most important causes of postoperative anxiety. Postoperative pain begins with surgical trauma and gradually decreases with wound healing. It should be treated effectively due to metabolic changes it caused in postoperative period. Although increased postoperative analgesic requirements was shown in smokers, the effect of passive smoking on postoperative analgesic requirement has not studied. The aim of this study was to evaluate whether any difference regarding perioperative hemodynamic data, postoperative analgesic requirements, adverse effects, patient satisfaction, sedation and visual analog scores between smokers, passive smokers and non-smokers.Materials and Methods: After obtaining approval from ethic committee and written, informed consent, 90 ASA I-II patients undergoing abdominal hysterectomy were included into the study and one day before surgery smoking history was obtained. Patients randomly divided into three groups, smokers, (Group I, n=30), non-smokers (Group II, n=30), passive smokers (Group III, n=30). No premedication was administered to any patients. Patients were monitorized in the operating room. Standart anesthesia was administered to the all patients. After extubation PCA was started with loading dose and patients were taken to recovery room after obtaining response to verbal stimulus. Non-invasive arterial pressure, heart rate, respiratuar rate, peripheral oxygen saturation, fentanyl consumption, nausea and vomiting, patient satisfactory, sedation and visual analog scores were recorded at 2, 4, 6 and 24th hours after operation.Results: Total fentanyl consumption was 594, 16±49, 04 µg in Group I, 446, 80±51, 87 µg Group II, 534, 11±52, 16 µg Group III. Fentanyl consumption in Group I was higher at all times than Group II, and at recovery time and at 24th hours than Group III (p< 0.05). Fentanyl consumption in Group III was higher at 24th hours than in Group II (p< 0.05). Postoperative VAS resting score in Group I was higher at recovery time, 4, 6 and 24th hours than Group II, and at recovery time and 2 th hours than Group III (p< 0.05). Postoperative VAS movement score in Group I was higher at 4, 6 and 24th hours than Group II, and at 2, 4, 6 and 24th than Group III (p< 0.05). Postoperative VAS movement scores in Group III was higher at 24th hours than in Group II (p< 0.05). Patient satisfaction score in Group I was higher at 2 and 24th hours than group II, and at 2, 4, 6 and 24th hours than Group III (p< 0.05). There was no significant difference about adverse effects between gruops at the same time nausea and vomiting incidence more Grup II than Grup I and Grup III.Conclusion: It was concluded that although there were no difference regarding perioperative hemodynamic data, adverse effects except PONV and patient sedation scores between smokers, passive smokers and non-smokers, there was increased postoperative analgesic requirement in smokers and passive smokers. The incidence of PONV was 50% lower than non-smokers.Key words: Smoke, environmental smoking, postoperative pain, patient controlled analgesia.