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

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 demographic 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 requirements 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 compared 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 associated with differences in postoperative opioid use.