[Effects of smoking on venous cannulation pain: a randomized prospective trial]

Opiate Pain Medication Consumption in Cigarette Smokers following Total Hip Arthroplasty

Purpose  The purpose of the present study was to assess perception of pain and pain management in smokers versus nonsmokers who received a total hip arthroplasty (THA).

Methods  Patients who underwent THA from 2010 to 2016 were propensity score matched 1:1 based on race, body mass index, age, and sex. This yielded 124 smokers and 124 nonsmokers. Pain intensity was quantified using area under the curve for visual analog scale pain scores. Opioid consumption was determined using a morphine milliequivalent (mEq) conversion algorithm. An independent samples t -test and Chi-square analysis was conducted to assess continuous and categorical variables respectively.

Results  Smokers experienced a nonsignificantly increased pain intensity (198.1 vs. 185.7; p  = 0.063). Smokers demonstrated significantly higher opioid consumption in both immediate postoperative (65.9 vs. 59.3 mEq; p  = 0.045) and 90 days postoperative periods (619.9 vs. 458.9 mEq; p  = 0.029).

Conclusion  Our study demonstrated a nonsignificantly increased pain intensity, and (in both the immediate and 90 days postoperative periods) a significantly higher opioid consumption following THA in patients who smoke cigarettes. This may be due to a relatively small effect size, warranting the need for larger prospective studies. Nevertheless, arthroplasty surgeons should encourage preoperative smoking cessation and alternative nonopioid analgesics to smoking patients receiving THA.

Level of Evidence  This is a level III, retrospective cohort study.

Does intrauterine tobacco exposure increase the pain perception of newborns?

Background

This study aimed to assess whether there was a difference in the pain-perception levels of newborns born to mothers who smoked during pregnancy and newborns born to mothers who were not exposed to active or passive smoking during pregnancy.

Materials and methods

A total of 60 newborns born by normal spontaneous vaginal birth between June 2013 and June 2014 were included in the study: 30 born to mothers who smoked during pregnancy, and 30 born to mothers not exposed to smoking. Mothers or newborns who had taken analgesics or sedative medications in the previous 24 hours, newborns not born at term, and sick newborns were not included in the study. During the routine hepatitis B-vaccination injection given at postnatal 48 hours, the newborns’ behavior was monitored and recorded by video camera. The data obtained from the recordings were evaluated according to the Neonatal Pain, Agitation, and Sedation Scale and analyzed with SPSS 20.

Results

The median pain score of the group exposed to tobacco smoke in utero was 8.5, while the median pain score of the unexposed group was 6 (P<0.001).

Conclusion

Exposure to tobacco smoke in utero may increase the pain-perception levels of newborns.