Postoperative opiate analgesia requirements of smokers and nonsmokers

Ann Pharmacother. 2004 Jun;38(6):949-53. doi: 10.1345/aph.1D580. Epub 2004 Apr 27.


Background: Smoking cigarettes and other forms of nicotine administration appear to blunt the perception of pain. Abrupt discontinuation of nicotine in nicotine-dependent patients appears to increase the perception of pain. The clinical importance of nicotine's effect on pain perception is not fully understood.

Objective: To determine whether smokers who abruptly discontinue smoking as a result of being hospitalized for coronary artery bypass graft (CABG) require more postoperative opiate analgesics than nonsmokers.

Methods: A retrospective review of patients who underwent a CABG was performed. Smokers (n = 20) were compared with nonsmokers (n = 69) with regard to opiate analgesic use during the first 48 hours postoperatively. The use of nonopiate sedatives was also compared between the groups.

Results: When normalized for weight and body mass index, smokers required 23% and 33%, respectively, more opiate analgesics than did nonsmokers (p = 0.027 and 0.023, respectively). The percentage of patients who received benzodiazepines postoperatively was similar in the 2 groups.

Conclusions: In this study, smokers deprived of nicotine required a greater amount of opiates in the first 48 hours after CABG than did nonsmokers. Healthcare providers need to be aware of the potential for increased narcotic requirements among nicotine-deprived smokers. Further study is needed to determine whether nicotine replacement lessens the requirement for postoperative analgesics in smokers.

MeSH terms

  • Aged
  • Analgesics, Opioid / administration & dosage*
  • Analgesics, Opioid / therapeutic use*
  • Benzodiazepines / administration & dosage
  • Benzodiazepines / therapeutic use
  • Coronary Artery Bypass / adverse effects
  • Female
  • Hospitalization
  • Humans
  • Male
  • Middle Aged
  • Pain, Postoperative / drug therapy*
  • Pain, Postoperative / etiology
  • Retrospective Studies
  • Substance Withdrawal Syndrome / drug therapy
  • Substance Withdrawal Syndrome / etiology
  • Tobacco Use Disorder / complications*


  • Analgesics, Opioid
  • Benzodiazepines