Article Data

  • Views 1669
  • Dowloads 137

Original Research

Open Access

Influence of tobacco use on postoperative opiate analgesia requirements in patients undergoing coronary artery bypass graft surgery

  • YU SHI1

1Department of Anesthesiology College of Medicine, Mayo Clinic

2,Mayo Medical Student College of Medicine Mayo Clinic

3,Department of Health Sciences Research (statistician) College of Medicine Mayo Clinic

DOI: 10.22514/SV62.102011.10 Vol.6,Issue 2,October 2011 pp.72-77

Published: 31 October 2011

*Corresponding Author(s): TOBY N. WEINGARTEN E-mail:


Introduction. The objective of this study was to test the hypothesis that tobacco use status is independently associated with postoperative opioid requirements in patients undergoing coronary artery bypass grafting (CABG) when important demograp-hic variables such as age and gender are taken into account.

Methods. A retrospective chart review of patients who underwent CABG surgery over a one year period at Mayo Clinic in Rochester, MN was performed. Tobacco users (N=69) were compared to nonusers (N=345) with regards to opiate require-ments and the occurrence of severe pain during the first 48 hours postoperatively. For comparison, all postoperative opiates were converted to oral morphine equivalents (OME). Adjusted analysis for age and gender was also performed.

Results. Tobacco users were younger than nonusers (P < 0.001), and a greater proportion of former users were male compa-red to never users (P = 0.003). Tobacco users had greater mean opiate requirements 401 ± 284 than nonusers 314 ± 240 mg OME, (P = 0.009). However, the association between tobacco use and greater postoperative opiate requirements lost significance after adjustment for age and gender. Tobacco use was not associated with increased risk of the development of severe pain (P = 0.51).

Conclusions. Although current tobacco users undergoing CABG surgery utilize more opioid analgesics in the first 48 hours following extubation than nonusers of tobacco, when adjusted for age and gender, tobacco use was not independently asso-ciated with differences in postoperative opioid use.


tobacco use, postoperative opiates, acute pain, coronary artery bypass surgery

Cite and Share

TOBY N. WEINGARTEN,ELIZABETH A. ERIE,YU SHI,DARRELL R. SCHROEDER,MARTIN D. ABEL,DAVID O. WARNER. Influence of tobacco use on postoperative opiate analgesia requirements in patients undergoing coronary artery bypass graft surgery. Signa Vitae. 2011. 6(2);72-77.


1. Girdler SS, Maixner W, Naftel HA, Stewart PW, Moretz RL, Light KC. Cigarette smoking, stress-induced analgesia and pain perception in men and women. Pain 2005;114(3):372-85.

2. Flood P, Daniel D. Intranasal nicotine for postoperative pain treatment. Anesthesiology 2004;101(6):1417-21.

3. Habib AS, White WD, El Gasim MA, Saleh G, Polascik TJ, Moul JW, et al. Transdermal nicotine for analgesia after radical retropubic pro-statectomy. Anesth Analg 2008;107(3):999-1004.

4. Hong D, Conell-Price J, Cheng S, Flood P. Transdermal nicotine patch for postoperative pain management: a pilot dose-ranging study. Anesth Analg 2008;107(3):1005-10.

5. Turan A, White PF, Koyuncu O, Karamanliodlu B, Kaya G, Apfel CC. Transdermal nicotine patch failed to improve postoperative pain management. Anesth Analg 2008;107(3):1011-7.

6. Vogt MT, Hanscom B, Lauerman WC, Kang JD. Influence of smoking on the health status of spinal patients: The National Spine Network Database. Spine 2002;27:313-19.

7. Weingarten TN, Iverson BC, Shi Y, Schroeder DR, Warner DO, Reid KI. Impact of Tobacco Use on the Symptoms of Painful Temporoman-dibular Joint Disorders. Pain 2009;in press.

8. Weingarten TN, Podduturu VR, Hooten WM, Thompson JM, Luedtke CA, Oh TH. Impact of Tobacco Use in Patients Presenting to a Multi-disciplinary Outpatient Treatment Program for Fibromyalgia. Clin J Pain 2009;25(1):39-43.

9. Warner DO, Patten CA, Ames SC, Offord K, Schroeder D. Smoking behavior and perceived stress in cigarette smokers undergoing elective surgery. Anesthesiology 2004;100(5):1125-37.

10. Berge TI. Pattern of self-administered paracetamol and codeine analgesic consumption after mandibular third-molar surgery. Acta Odontol Scand 1997;55(5):270-6.

11. Creekmore FM, Lugo RA, Weiland KJ. Postoperative opiate analgesia requirements of smokers and nonsmokers. Ann Pharmacother 2004;38(6):949-53.

12. Woodside JR. Female smokers have increased postoperative narcotic requirements. J Addict Dis 2000;19(4):1-10.

13. Gagliese L, Jackson M, Ritvo P, Wowk A, Katz J. Age is not an impediment to effective use of patient-controlled analgesia by surgical patients. Anesthesiology 2000;93(3):601-10.

14. Macintyre PE, Jarvis DA. Age is the best predictor of postoperative morphine requirements. Pain 1996;64(2):357-64.

15. Ready LB. Acute pain: lessons learned from 25,000 patients. Reg Anesth Pain Med 1999;24(6):499-505.

16. Joels CS, Mostafa G, Matthews BD, Kercher KW, Sing RF, Norton HJ, et al. Factors affecting intravenous analgesic requirements after colectomy. J Am Coll Surg 2003;197(5):780-5.

17. Chia YY, Chow LH, Hung CC, Liu K, Ger LP, Wang PN. Gender and pain upon movement are associated with the requirements for posto-perative patient-controlled iv analgesia: a prospective survey of 2,298 Chinese patients. Can J Anaesth 2002;49(3):249-55.

18. Morris RJ, Butler MT, Samuels LE. Minimally invasive saphenous vein harvesting. Ann Thorac Surg 1998;66(3):1026-8.

19. Management of Cancer Pain; Clinical Practice Guideline Number 9. Agency for Health Care Policy and Research Publication No. 94-0592. U.S. Dept. of Health and Human Services, 1994.

20. Principles of Analgesic Use in the Treatment of Acute Pain and Cancer Pain. 4th edition ed. Skokie, Illinois: American Pain Society, 1999.

21. Fudin J, Toledo-Binette C, Kupiak DM, Johnston KR, Smith HS. Quicker dosage adjustment for transdermal fentanyl. Am J Health Syst Pharm 1997;54(1):87-8.

22. Zech DF, Grond SU, Lynch J, Dauer HG, Stollenwerk B, Lehmann KA. Transdermal fentanyl and initial dose-finding with patient-controlled analgesia in cancer pain. A pilot study with 20 terminally ill cancer patients. Pain 1992;50(3):293-301.

23. Bodian CA, Freedman G, Hossain S, Eisenkraft JB, Beilin Y. The Visual Analog Scale for Pain: Clinical Significance in Postoperative Patients. Anesthesiology 2001;95(6):1356-61.

24. Serlin RC, Mendoza TR, Nakamura Y, Edwards KR, Cleeland CS. When is cancer pain mild, moderate or severe? Grading pain severity by its interference with function. Pain 1995;61(2):277-84.

25. Andersson H, Ejlertsson G, Leden I. Widespread musculoskeletal chronic pain associated with smoking. An epidemiological study in a general rural population. Scand J Rehabil Med 1998;30(3):195-91.

26. John U, Hanke M, Meyer C, Volzke H, Baumeister SE, Alte D. Tobacco smoking in relation to pain in a national general population survey. Prev Med 2006;43:477-81.

27. Center for Disease Control. Cigarette Smoking Among Adults - United States, 2007. Morbidity and Mortality Weekly Report 2008:1221-6.

28. Patrick DL, Cheadle A, Thompson DC, Diehr P, Koepsell T, Kinne S. The validity of self-reported smoking: a review and meta-analysis. Am J Public Health 1994;84(7):1086-93.

Abstracted / indexed in

Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,200 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Chemical Abstracts Service Source Index The CAS Source Index (CASSI) Search Tool is an online resource that can quickly identify or confirm journal titles and abbreviations for publications indexed by CAS since 1907, including serial and non-serial scientific and technical publications.

Index Copernicus The Index Copernicus International (ICI) Journals database’s is an international indexation database of scientific journals. It covered international scientific journals which divided into general information, contents of individual issues, detailed bibliography (references) sections for every publication, as well as full texts of publications in the form of attached files (optional). For now, there are more than 58,000 scientific journals registered at ICI.

Geneva Foundation for Medical Education and Research The Geneva Foundation for Medical Education and Research (GFMER) is a non-profit organization established in 2002 and it works in close collaboration with the World Health Organization (WHO). The overall objectives of the Foundation are to promote and develop health education and research programs.

Scopus: CiteScore 1.0 (2022) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.

Embase Embase (often styled EMBASE for Excerpta Medica dataBASE), produced by Elsevier, is a biomedical and pharmacological database of published literature designed to support information managers and pharmacovigilance in complying with the regulatory requirements of a licensed drug.

Submission Turnaround Time