Abstract

Objectives: Smokers had higher risk than nonsmokers for pain. The incidence of pain on injection of propofol has been reported to be 70%. We explored the relationship between smoking habits and propofol injection pain, whether nicotine replacement has an influence on intensity or incidence of pain associated with propofol in smokers.

Patients and Methods: Two hundred patients ASA (American Society of Anesthesiologists) physical status 1, undergoing elective surgical procedures were studied. Hundred (50-50) patients who used cigarette were included in smoker group and nicotine group. Hundred (50-50) patients who never used tobacco were included in nonsmoker (NS) group and NS+nicotine group. Prior to surgery, the anesthesiologist gave a nicotine gum to nicotine group which was randomized in smokers and nonsmokers. The severity of propofol injection pain was evaluated using four point scale (none, mild, moderate, and severe).

Results: Incidence of pain was higher in the smoker group compared with the nonsmoker, nicotine and NS+nicotine groups. The intensity of mild pain was higher in the smoker group compared with the nonsmoker group. The intensity of moderate+severe pain was lower in the NS+nicotine group compared with the nonsmoker and smoker and nicotine groups.

Conclusion: The incidence of propofol injection pain and intensity of mild pain increased in smokers deprived of nicotine. Nicotine replacement in these patients reduced the incidence of propofol injection pain similar to nonsmokers. When nonsmokers were given nicotine, intensity of moderate+severe pain decreased. These results suggest that smokers' awareness of pain increases and nicotine has an analgesic effect.