Smoking increases chronic postsurgical pain in patients undergoing open abdominal hysterectomy

Abstract

Objectives: Smoking cause severe postoperative complications. Cotinine is the end product of nicotine in the urine. Our primary hypothesis was that women with high preoperative urinary cotinine levels have more postsurgical chronic/acute pain is tested, and secondarily, that high cotinine levels are associated with more opioid consumption. Method: 158 patients undergoing open abdominal hysterectomy were divided into three groups according to the cotinine level. 1)Low Cotinine group ˂10ng/dl (no exposure), 2) Intermediate Cotinine group =10-500ng/dl (exposure), 3) High Cotinine group ˃500ng/dl (smoker). In postoperative 3 months, postsurgical chronic pain, allodynia score, pain limiting daily activity, Brief Pain Inventory, SF 12 form, Douleur Neuropathique en 4 (DN4) questions test, and Sleep interference test were assessed. Visual Analogue Scale (VAS), morphine consumption, rescue analgesic consumption, and complications were recorded during postoperative 48 hours. Results: The postsurgical chronic pain scores at the three months(p˂0,007), the postoperative pain scores and opioid consumption were significantly higher in the high cotinine group. High cotinine group had significantly worst HADS, SF 12 PCS, allodynia, and sleep interference test scores. Conclusion: Smoking and tobacco smoke exposure are associated with high postsurgical chronic pain, and also postoperative acute pain with more opioid consumption.