Duration of Cessation of Smoking before Elective Surgery: Impact on Intraoperative Hemodynamics and Early Postoperative Pain in Developing Country

Abstract

Aim and Background: It is estimated that up to 20% of patients coming for elective surgery are smokers and carry a risk of perioperative complications. Though smoking cessation and its impact on perioperative outcome are widely investigated worldwide we were unable to find any data in Pakistan. The objective of the study is to determine the impact of the duration of smoking cessation before elective surgery on intraoperative hemodynamics and postoperative pain in Pakistani population. Methods: It was a prospective cohort study conducted at the Aga Khan University Hospital Karachi, Pakistan, for one-year duration. A total of 260 patients scheduled for elective noncardiac surgery under general anaesthesia were recruited. Surgery under regional anaesthesia and minor surgery under general anaesthesia were excluded. Data on self-reported duration of smoking cessation by patients, intraoperative haemodynamics, postoperative pain scores and duration of hospital stay were collected by independently trained data collectors from the preoperative area until the patient is discharged from the hospital. Results: A data from 256 patients were analyzed. On the basis of self-reported duration of preoperative smoking cessation, patients were divided into 4 groups (Group 1: less than 2 days, Group 2: more than 2 days to 7 days, Group 3: more than 7 days to 4 weeks and Group 4: more than 4 weeks). It was found that the longer the duration of cessation of smoking is the less haemodynamic changes and lower postoperative pain scores. Length of stay did not show any difference among all four groups. No major postoperative pulmonary complication was found in any study patient. Conclusions: Duration of cessation of smoking before elective surgery is a significant predictor of intraoperative

The Effect of Smoking Cessation on Acute Pain: A Systematic Review

“…The included studies collectively represented data four countries: the USA (n = 8), China (n = 3), Pakistan (n = 1), and the Republic of Korea (n = 1). The oldest study was published in 2000 [34], and the rest were published between 2004 and 2021 [3,17,[37][38][39][40][41][42][43][44][45][46].…”

“…Overall, 43.3% of the included individuals were females. Three studies presented data exclusively from males [ 41 , 45 , 46 ], one from females [ 34 ], and one did not report gender outcomes [ 44 ]. One paper dealt with pain in adolescents aged 14–18 years [ 37 ], while the remaining dealt with adult patients, some without age limitations [ 38 , 43 ].…”

“…The duration of smoking cessation varied considerably. The shortest duration was 2 h [ 3 ]; others investigated the effect after more than 1 month of smoking cessation [ 41 , 44 ]. Smokers had a history of 14.6 ± 9.9 years of nicotine abuse.…”

“…Postoperative pain was the most frequently studied acute pain condition: six studies reported postoperative pain assessments and opioid requirements [34,40,41,[44][45][46], five investigated the need for analgesic medication [34,38,40,41,46], and five reported pain intensity [17,33,39,42,45]. One study involved pulmonary resection [46], one involved laparoscopic gastrectomy [41], one involved liver resection [45], one involved…”

“…As the duration of smoking cessation increased, the amount of postoperative opioid requirements decreased On POD 0, the NRS score in patients who had ceased smoking within 1 month of surgery, was significantly higher than that in non-smokers or smokers who had ceased smoking more than 1 month before surgery coronary artery bypass grafting [40], one pelvic/ gynecological surgeries (cesarean section, vaginal, and abdominal hysterectomies) [34,41], and one study involved scheduled noncardiac surgery [44]. These studies corroborated our hypothesis that there is an increased postoperative need for opioids after nicotine withdrawal.…”