The effect of cigarette consumption on postoperative opioid requirement in patients undergoing laparoscopic cholecystectomy

Öz

Aim: Nicotine, a substance present in cigarette smoke, exerts its pharmacological effects through the nicotinic acetylcholine receptor on target cells. Stimulation of nicotinic acetylcholine receptor leads to the release of opioids. This study aims to compare postoperative analgesic consumption among individuals in smoker, non-smoker, and former smoker groups who have undergone laparoscopic cholecystectomy. Method: Following approval of the Mersin University Faculty of Medicine Clinical Trials Ethics Committee, a retrospective review was conducted on patients who underwent laparoscopic cholecystectomy between May 2017 and May 2018 at the Department of General Surgery of Mersin University Hospital. The patient information registry system was utilized for data extraction. Inclusion criteria encompassed patients undergoing elective operations, aged over 18 years, and possessing an American Society of Anaesthesiologists score of Group I–III. Patients were categorized into three groups: smokers (Group I), non-smokers (Group II), and former smokers (Group III). Results: The study included a total of 100 patients. When comparing opioid consumption and the smoking status of the patients, it was observed that the total opioid consumption within the first 24 hours postoperative was higher in Group I than in Groups II and III (p<0.05). Conclusion: Smoking negatively affects postoperative pain. We believe healthcare providers should be mindful of the increased postoperative opioid requirements in individuals who were cigarette users but have stopped smoking preoperatively. Consequently, analgesia procedures should be managed accordingly.

Anahtar Kelimeler

• Smoking
• postoperative pain
• laparoscopic cholecystectomy

Laparoskopik kolesistektomi operasyonu uygulanan hastalarda sigara tüketiminin postoperatif opioid gereksinimi üzerine etkisi

Öz

Amaç: Sigara dumanında bulunan maddelerden biri olan nikotin, farmakolojik etkilerini hedef hücreler üzerinde bulunan nikotinik asetilkolin reseptörü üzerinden göstermektedir. Nikotinik asetilkolin reseptörlerindeki uyarılmalar opioid salınmasına neden olmaktadır. Bu çalışmada laparoskopik kolesistektomi operasyonu uygulanmış sigara kullanan, kullanmayan ve sigara kullanmayı bırakmış hasta gruplarında postoperatif analjezik ajan tüketiminin karşılaştırılması amaçlandı. Yöntem: Mersin Üniversitesi Tıp Fakültesi Klinik Çalışmalar Etik Kurulu onayı alındıktan sonra Mersin Üniversitesi Tıp Fakültesi Hastanesi Genel Cerrahi Anabilim Dalı tarafından Mayıs 2017 - Mayıs 2018 tarihleri arasında laparoskopik kolesistektomi operasyonu uygulanmış hastalar, hasta bilgi kayıt sisteminden retrospektif olarak tarandı. Elektif şartlarda opere edilmiş, 18 yaş üstünde, Amerikan Anestezi Derneği Skoru I-III olan hastalar çalışmaya dahil edildi. Hastalar sigara kullanan (Grup I), kullanmayan (Grup II) ve sigara kullanmayı bırakanlar (Grup III) olarak 3 gruba ayrıldı. Bulgular: Araştırmaya toplam 100 hasta dahil edildi. Hastaların opioid tüketimi ile sigara kullanma durumları karşılaştırıldığında; postoperatif 24 saatte toplam opioid tüketiminin Grup I’de, Grup II ve III’e göre daha yüksek olduğu belirlendi (p<0.05). Sonuç: Sigaranın postoperatif ağrı üzerine olumsuz etkisi olduğu belirlenmiştir. Sağlık hizmeti sağlayıcılarının perioperatif sigara kullanımı durdurulan sigara kullanıcılarının postoperatif artan oranda opioid gereksinimlerinin farkında olmaları ve analjezi prosedürlerini buna göre düzenlemeleri gerektiğini düşünmekteyiz.

Anahtar Kelimeler

• sigara
• postoperatif ağrı
• laparoskopik kolesitektomi

Kaynakça

1. Shavit Y, Fridel K, Beilin B. Postoperative pain management and proinflammatory cytokines: animal and human studies. J Neuroimmune Pharmacol. 2006 Dec;1(4):443-51.
2. Pogatzki-Zahn EM, Zahn PK, Brennan TJ. Postoperative pain--clinical implications of basic research. Best Pract Res Clin Anaesthesiol. 2007 Mar;21(1):3-13.
3. LaRowe LR, Kosiba JD, Zale EL, Ditre JW. Effects of nicotine deprivation on current pain intensity among daily cigarette smokers. Exp Clin Psychopharmacol 2018 Oct;26(5):448-455.
4. Matthews AM, Fu R, Dana T, Chou R. Intranasal or transdermal nicotine for the treatment of postoperative pain. Cochrane Database Syst Rev, 2016 Jan 12;(1):CD009634.
5. Kishioka S, Kiguchi N, Kobayashi Y, Saika F. Nicotine effects and the endogenous opioid system. J Pharmacol Sci. 2014;125(2):117-24.
6. Ditre JW, Zale EL, LaRowe LR, Kosiba JD, Vita MJ. Nicotine deprivation increases pain intensity, neurogenic inflammation and mechanical hyperalgesia among daily tobacco smokers. Journal of Abnormal Psychology, 2018;127(6):578-89
7. Woodside JR. Female smokers have increased postoperative narcotic requirements. Journal of addictive diseases, 2000;19:1-10.
8. Zhao S, Chen F, Wang D, Wang H, Han W, Zhang Y. Effect of preoperative smoking cessation on postoperative pain outcomes in elderly patients with high nicotine dependence. Medicine (Baltimore),2019 Jan;98(3):e14209.

9. Hartmann-Boyce J, Chepkin SC, Ye W, Bullen C, Lancaster T. Nicotine replacement therapy versus control for smoking cessation. Cochrane Database Syst Rev, 2018 May 31;5(5):CD000146.
10. Creekmore FM, Lugo RA, Weiland KJ. Postoperative opiate analgesia requirements of smokers and nonsmokers. Annals of Pharmacotherapy, 2004;38:949-53.
11. Aydogan MS, Ozturk E, Erdogan MA, et al. The effects of secondhand smoke on postoperative pain and fentanyl consumption. J Anesth. 2013;27(4):569-574.
12. Weingarten TN, Erie EA, Shi Y, Schroeder DR, Abel MD, Warner DO. Influence of tobacco use on postoperative opiate analgesia requirements in patients undergoing coronary artery bypass graft surgery. Signa vitae: journal for intesive care and emergency medicine, 2011;6:72-7.
13. Kim DH, Park JY, Karm M-H, et al. Smoking May Increase Postoperative Opioid Consumption in Patients Who Underwent Distal Gastrectomy With Gastroduodenostomy for Early Stomach Cancer. The Clinical journal of pain, 2017;33:905-11.
14. Fowler CD, Turner JR, Imad Damaj M. Molecular Mechanisms Associated with Nicotine Pharmacology and Dependence. Handb Exp Pharmacol, 2020;258:373-393.
15. Elhassan S, Bagdas D, Damaj MI. Effects of Nicotine Metabolites on Nicotine Withdrawal Behaviors in Mice. Nicotine Tob Res, 2017 Jun 1;19(6):763-766.
16. Hall BJ, Wells C, Allenby C et al. Differential effects of non-nicotine tobacco constituent compounds on nicotine self-administration in rats. Pharmacol Biochem Behav, 2014 May;120:103-8.
17. Harris AC, Tally L, Muelken P et al. Effects of nicotine and minor tobacco alkaloids on intracranial-self-stimulation in rats. Drug Alcohol Depend, 2015 Aug 1;153:330-4.
18. Kolokotroni KZ, Rodgers RJ, Harrison AA. Effects of chronic nicotine, nicotine withdrawal and subsequent nicotine challenges on behavioural inhibition in rats. Psychopharmacology (Berl), 2012 Jan;219(2):453-68.
19. Li L, Jia K, Zhou X, McCallum SE, Hough LB, Ding X. Impact of nicotine metabolism on nicotine's pharmacological effects and behavioral responses: insights from a Cyp2a(4/5)bgs-null mouse. J Pharmacol Exp Ther. 2013 Dec;347(3):746-54.
20. Xue Y, Morris M, Ni L et al. Venous plasma nicotine correlates of hormonal effects of tobacco smoking. Pharmacol Biochem Behav. 2010 Apr;95(2):209-15.
21. Morris MC, Mielock AS, Rao U. Salivary stress biomarkers of recent nicotine use and dependence. Am J Drug Alcohol Abuse, 2016 Nov;42(6):640-648.
22. Li S, Guan S, Wang Y et al. Nicotine inhibits rapamycin-induced pain through activating mTORC1/S6K/IRS-1-related feedback inhibition loop. Brain Res Bull. 2019 Jul;149:75-85.
23. Di Cesare Mannelli L, Zanardelli M, Ghelardini C. Nicotine is a pain reliever in trauma- and chemotherapy-induced neuropathy models. Eur J Pharmacol. 2013 Jul 5;711(1-3):87-94.
24. Flood P, Daniel D. Intranasal nicotine for postoperative pain treatment. Anesthesiology: The Journal of the American Society of Anesthesiologists, 2004;101:1417-21.
25. Weingarten TN, McGlinch BP, Liedl L, et al. Intranasal nicotine increases postoperative nausea and is ineffective in reducing pain following laparoscopic bariatric surgery in tobacco-Naïve females: a randomized, double blind trial. Obes Surg. 2015 Mar;25(3):506-13.