Clinical Observation On The Effect Of Different Smoking Cessation Time On Postoperative Analgesia

Objective:The aim of our study was to investigate the effects of different smoking cessation time on opioid requirement of patients after thoracoscopic lung cancer radical surgery in highly-nicotine dependent patients.Methods:After the approval of the ethics committee at the first hospital of Norman Bethune in Jilin University,the patients were selected to receive thoracoscopic lung cancer radical Surgery during January 2017~January 2018.Patients were required to have no basal heart and lung disease,aged 60~70,ASA I~II.Exclusion criteria: 1.history of alcoholism and opioid abuse.2.pain allergies.3.rejection participants.4.receive second operation within 24 h.5.cannot correctly use PCIA(patient controlled intravenous analgesia,PCIA)and cannot understand VAS(visual analog score,VAS).6.have mental or neurological dysfunction and postoperative cognitive dysfunction.7.preoperative assessment of patients with difficult airway.8.history of chronic passive smoking(non-smoking group requires excluding this condition).According to smoking cessation time and smoking situation,patients will be divided into 3 groups,Group A: Smoking cessation group(1~2 weeks),n=40,Group B: Smoking cessation group(4~6 weeks),n=40,Group C: Non-smokers group(cumulative smoking less than 100 cigarettes),n=40.Groups A and B are required to pass the FTND(fagerstrom test of nicotine dependence,FTND)evaluation and score of FTND are required?6 points.We used sufentanil 0.35ug/kg?etomidate 0.3mg/kg and Homeopathic atracurium 0.15 mg/kg for anesthesia induction.During the operation,Propofol and remifentanil were continuously pumped into at the rate of 5 mg/kg·h and 6?g/ kg·h,and Sevoflurane is also used during surgery.Homeopathic atracurium was interrupted intermittently at the rate of 0.08mg/kg according to demand.Sufentanil 0.2ug/kg and ondansetron 4mg were given before the end of surgery.In order to prevent the interference of the intraoperative anesthesia in this experiment,we maintained the BIS(bispectral index,BIS)value within 40-60 range.We pulled the endotracheal tube out after surgery.After that we used electronic analgesia pump to analgesia and recorded the consumption of sufentanil within 48 hours after surgery.Analgesic pump configuration: sufentanil 1ug/ml and ondansetron 80ug/ml.Analgesic Pump parameter setting: No background dose,single dose 3ml,locking time 10 min,4h limited 40 ml.We used PCIA to analgesic and used VAS to assess the postoperative pain.VAS of 3 groups were recorded at 1h?2h?4h?8h?12h?24h and 48 h.In addition,we recorded the consumption of sufentanil at 6h,12 h,24h and 48 h,and compared the effects of different quit smoking time on sufentanil consumption during postoperative analgesia.Results:(1)general information of 3 groups and remifentanil consumption during operation have no statistically significant difference(P<0.05)(2)VAS comparison: The VAS in Group A and group B was higher than Group C(P<0.05),and the VAS in Group A was higher than Group B(P<0.05).(3)sufentanil consumption comparison at 6h?12h?24h and 48h:Group A: 31.47±3.558,57.81 ±5.786,98.28±9.126,182.61±8.936.Group B: 27.39±2.646,48.21 ±5.036,81.66±4.867,142.66±5.629.Group C: 22.45 ± 2.659,34.67 ± 4.277,69.55 ± 6.428,126.03 ± 8.338.The sufentanil consumption in group A and group B was higher than that in Group C(P<0.05),and sufentanil consumption in Group A was higher than that in Group B(P<0.05).Conclusion:(1)The consumption of sufentanil and VAS in patients with high nicotine dependence who received radical cancer surgery were higher than those in the Non-smoking group.(2)The consumption of sufentanil and VAS decreased more obviously in patients who quitted smoking for 4~6 weeks than in patients who quitted smoking for 1 to 2 weeks.