INTRODUCTION: Effective postoperative pain management is crucial for patient recovery and satisfaction. Smoking may impact pain perception and analgesic requirements, but its effects on postoperative opioid needs remain unclear. The objective of this study was to determine whether patients who smoke have different postoperative opioid requirements compared to nonsmokers in the first 24 and 48 h after surgery. METHODS: We conducted a systematic review and meta-analysis of studies comparing postoperative opioid use between smokers and nonsmokers. A comprehensive literature search was performed in Web of Science and PubMed databases. Opioid doses were converted to morphine equivalents for comparison. Random effects meta-analysis was used to calculate pooled effect sizes. RESULTS: Eight studies (784 patients) were included for the primary 24-h outcome and seven studies (1164 patients) for the 48-h outcome. Meta-analysis showed significantly higher opioid requirements in smokers compared to nonsmokers at both 24 h (standardized mean difference [SMD] 0.90, 95% CI 0.74-1.06, p < 0.00001) and 48 h postoperatively (SMD 0.61, 95% CI 0.48-0.74, p < 0.00001). On average, smokers required 33.7% more opioids than nonsmokers. Smokers also reported significantly higher pain scores 24 h after surgery (SMD 0.59, 95% CI 0.26-0.92, p < 0.001). CONCLUSIONS: Despite low-quality evidence due to non-randomized study designs, this meta-analysis demonstrates that patients who smoke have significantly higher postoperative opioid requirements and pain scores than nonsmokers. These findings highlight the need to consider smoking status when developing postoperative pain management strategies. Further research is needed to elucidate the mechanisms underlying this relationship and optimize pain control in smokers.
Pain+Ther 2025 ; ? (?): ?
