Chronic Smoking is Not Associated with Increased Postoperative Opioid Use in Patients with Lung Cancer or Esophageal Cancer

Abstract

Background: Chronic smokers show differences in pain sensitivity compared to healthy non-smokers. Yet, no study to date has examined whether smoker status has an effect on postoperative pain. Objective: We aim to examine a possible correlation between preoperative smoking and postoperative opioid dose based on the hypothesis that smokers would use higher doses of opioids to manage increased postoperative pain. Study Design: A retrospective observational cohort study. Setting: The National Cancer Center in Korea. Methods: We examined medical record data for patients who had undergone curative resection for either lung or esophageal cancer (lobectomy or bilobectomy for lung cancer or an Ivor Lewis operation for esophageal cancer) between January 1, 2006 and December 31, 2010. We examined the correlation between the total preoperative average number of packs per day multiplied by years of cigarette smoking (pack-years) and morphine equivalent daily doses administered to patients after surgery, considering each type of cancer both individually and together. Partial correlation and regression analyses were performed to determine the causality of a possible relationship between pack-years of cigarette smoking and postoperative opioid dose. Results: A total of 1,129 patients (871 patients with lung cancer and 258 patients with esophageal cancer) were included in the final analysis. There was no significant correlation between total pack-years of cigarette smoking and postoperative opioid dose for lung cancer, esophageal cancer, or both cancer types combined (r = 0.042, -0.012, and 0.037, respectively). In the analysis of both cancer types combined, video-assisted thoracic surgery (VATS) was associated with an 11.1% decrease in opioid dose (β = -0.111, P = 0.003) and epidural analgesia was associated with a 7.2% increase in opioid dose (β = 0.072, P = 0.042). Limitations: The retrospective design of this study is a limitation. Conclusion: Our study did not observe a correlation between preoperative smoking and postoperative opioid dose in patients with lung or esophageal cancer. Key words: Smoking, postoperative pain, opioid, lung cancer, esophageal cancer, analgesia

Enhancement of Opioid Antinociception by Nicotine

“…This ratio could not be calculated for nalbuphine as response rate did not decrease as a function of nalbuphine dose. 2002; Kyte et al, 2018) and nicotine-opioid interactions (Patterson et al, 2012;Kishioka et al, 2014;Plesner et al, 2016;De Vita et al, 2019), the use of nicotine to promote opioid antinociception has not yet been systematically evaluated clinically, perhaps owing to previous reports of increased opioid use in tobacco users (Skurtveit et al, 2010;Yoon et al, 2015; but see Ackerman, 2012;Oh et al, 2018). However, the present results indicate that nonsmokers might benefit from the use of nicotine as an adjuvant for opioid analgesia, an idea that is supported by clinical data obtained in nonsmokers.…”

“…It has been reported that nicotine can induce the release of endogenous opioids, and that crosstolerance between nicotine and m-opioid agonists develops, coupled with changes in m-opioid receptor (MOR) expression levels (Kishioka et al, 2000). Some studies suggest that tobacco users are especially sensitive to chronic pain or require higher doses of opioids to manage chronic pain, possibly reflecting nicotineinduced crosstolerance to MOR agonists (Yoon et al, 2015; however, see Ackerman, 2012;Plesner et al, 2016;Oh et al, 2018;De Vita et al, 2019). However, as of 2017, only approximately 14% of the Americans smoked cigarettes (Centers for Disease Control and Prevention, 2018), leaving the possibility that a large nonsmoking population may benefit from nicotine's analgesic effects.…”

Moderate-severe postoperative pain in patients undergoing video-assisted thoracoscopic surgery: A retrospective study

“…More smokers underwent VATS compared with non-smokers, and it is therefore important to detect whether the increased risk for postoperative pain was smoking-related actually or if there was other explanations. And in VATS, the association between smoking history and postoperative pain was controversial 25,26 . The multiple analysis of this study indicated that presence of previous history of smoking increased the risk of moderate-severe acute pain following VATS by 86% (OR, 1.86; 95% CI, 1.29 to 2.70, P = 0.001).…”

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

“…10 Furthermore, accumulating evidence has indicated that cigarette smoking may influence narcotic requirement, pain severity, and the risk of chronic pain after surgery. [11][12][13][14][15][16][17][18][19][20][21][22] However, the association between smoking and opioid consumption or pain intensity is not clear due to conflicting results, with positive associations reported in some studies [11][12][13][14][16][17][18][19][20]22 but not in others. 15,21 In addition, some methodological drawbacks reduced the validity of previous studies, including small sample size (n < 1000), 11,14,[17][18][19][20][21][22] inadequate control for confounding factors, 11,19,22 and restriction to specific types of surgery.…”