Rev. Bras. Anestesiol. vol.65 número1

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RevBrasAnestesiol.2015;65(1):47---50

REVISTA

BRASILEIRA

DE

ANESTESIOLOGIA

OfficialPublicationoftheBrazilianSocietyofAnesthesiology

www.sba.com.br

SCIENTIFIC

ARTICLE

Effects

of

smoking

on

venous

cannulation

pain:

a

randomized

prospective

trial

Volkan

Hanci

a,∗

,

Hasan

Ali

Kiraz

b

,

Dilek

Ömür

a

,

Serpil

Ekin

b

,

Berna

Uyan

b

,

Derya

Arslan

Yurtlu

c

_,

_Serhan

_Yurtlu

a

a_Department_of_{Anesthesiology}_and_Reanimation,_Dokuz_Eylul_University_Medical_Faculty,_Konak,_Turkey

b_Department_of_{Anesthesiology}_and_Reanimation,_Canakkale_Onsekiz_Mart_University_Medical_Faculty,_Canakkale,_Turkey c_{Anesthesiology}_and_Reanimation_Clinic,_Katip_Celebi_University_Izmir_Ataturk_Education_and_Research_Hospital,_Izmir,_Turkey

Received6December2013;accepted13March2014

Availableonline29April2014

KEYWORDS

Smoking;

Venouscannulation; Pain

Abstract

Backgroundandobjectives: Ithasbeendemonstratedthatsmokingincreasespainperception; howevertheeffectofsmokingonperceptionofpainduringvenouscannulationisnotknown. Thepurposeofthisstudyistodeterminewhetherornotsmokinghasaneffectonpain percep-tionduetoperipheralvenouscannulation.

Methods:220patientsscheduledtohaveelectivesurgerywereenrolledinthestudyandwere dividedintotwogroups(GroupSandC,n=110foreach) accordingtotheir smokinghabits. Numericalratingscalewasintroducedtothepatientsandthenperipheralvenouscannulation atthedorsumofthehandwasmadewitha20Gintracath.Painperceptionofthepatientswas scoredbysubsequentnumericalratingscalequestioning.

Results:Thedemographiccharacteristicsofthegroupswereidentical.Numericalratingscale scoresinGroupSandCwere3.31±1.56and1.65±1.23,respectively(p<0.001).

Conclusion: Painperceptionduetoperipheralvenouscannulationishigherinsmokers.Future studiesonpaintreatmentshouldconsiderthesmokinghabitsofpatients.

∗_{Corresponding}_author.

E-mails:vhanci@gmail.com,volkanhanci@yahoo.com(V.Hanci).

http://dx.doi.org/10.1016/j.bjane.2014.03.004

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48 V.Hancietal.

PALAVRAS-CHAVE

HábitodeFumar; Cateterismo periférico; Dor

Efeitosdotabagismosobreadorduranteocateterismovenoso:umestudo prospectivoerandomizado

Resumo

Justificativaeobjetivos: Sabe-seque o tabagismo aumenta apercepção de dor; porém, o efeitodotabagismosobreapercepçãodadorduranteocateterismovenosonãoéconhecido.O objetivodesteestudofoideterminarseotabagismotemounãoalgumefeitosobreapercepção dadorduranteapunçãovenosaperiférica.

Métodos: Foramincluídosnoestudo220pacientesagendadosparacirurgiaeletiva randomica-mentealocadosemdoisgrupos:GrupoS(n=110)eGrupoC(n=110),deacordocomseushábitos tabagísticos.Ospacientesforaminstruídossobreousodaescalanuméricadeclassificac¸ãoda dore,emseguida,apunc¸ãovenosaperiféricafoifeitanodorsodamãocomum cateterde calibre20G(Intracath®_)._A_percepc_¸ão_de_dor_dos_pacientes_foi_{posteriormente}_registrada_de

acordocomosescoresdaescalanumérica.

Resultados: Ascaracterísticasdemográficasdosgruposeramidênticas.Osescoresdaescala numéricadedordosgruposSeCforam3,31±1,56e1,65±1,23,respectivamente(p<0,001).

Conclusão:Apercepc¸ãodadorporcausadapunc¸ãovenosaperiféricaémaioremfumantes. Estudos futuros sobre o tratamento da dor devem considerar os hábitos tabagísticos dos pacientes.

Introduction

PainisdefinedbytheInternationalAssociationfortheStudy ofPain asactualor potential tissuedamageaccompanied byan unpleasantsensory andemotional experience,or it isdefinedintermsofsuchdamage.1,2_For_this_reason_pain

shouldnotbeevaluatedaspurelyphysiologicalorsomatic.

Severityofpainsensationisaffectedbyenvironmental

fac-torsandsubjectivepersonalpastexperiences.Asaresult,

painofthesameintensitymaybeperceiveddifferentunder

similarconditions.3,4

Cigaretteusebringsmanyhealthproblems,suchasheart

and lung diseases, many different types of cancer and

asthma.Inadditionsmokingmaychangepainsensationand

postoperativeanalgesicrequirements.4---7

Intravenous(IV)catheterizationisoneofthemost

fre-quently used interventions for diagnostic and treatment

applications.IVcatheterizationfrequentlycausespainand

anxiety.4 _In _the _literature _there _are _many _studies _on_the

relationshipbetweenvenouscatheterizationandpain.

How-ever,moststudieshavenotincludedtheeffectofsmoking

onvenouscannulationpain.8---11

Thehypothesisofthisstudyisthatanadultsmokinghabit

willincreasethepainofvenouscatheterization.Totestthis

hypothesisthevenouscatheterizationpainofsmokingand

non-smokingpatientswasevaluated.Theprimaryoutcome

waspainscoreaftercannulation.

Materials

and

methods

CanakkaleOnsekizMartUniversityClinicalResearchEthics

Committee granted permission for this study (date:

16/05/2012,no:89,chairman:H.Aksulu).Writteninformed

consentswereobtainedfromthepatients whoenrolledin

thestudyandthestudywascompletedatCanakkaleOnsekiz

MartUniversitybetweenMay2012andJanuary2013.Atotal

of220malepatientsbetween18and65yearsofagewere

includedinthestudy.Patientshavinganychronicdiseases

especially neurologicalor psychiatric, communication

dif-ficulty,analgesic usewithintheprevious 24h, or havinga

previoushistoryoftraumaorneurologicdeficitatthehand

werenotincludedinthestudy.Patientsincludedinthestudy

werenotadministeredpremedication.

Patientstaken intothe operation roomwere informed

about the 10stepnumerical painscore.The smoking

his-tory of the patients wasrecorded. According to smoking

habitcasesweredividedinto2groups.Thesmokergroupof

patientshadahistoryof5yearsofsmokingformorethan5

cigarettesaday(GroupS,n=110).Thenon-smokinggroup

consisted of caseswho didnot smokeor whohadceased

smokingatleast1yearpreviously(GroupC,n=110).Venous

cannulationfor allcaseswascompletedby placinga20G

intracath in avein onthe backof thehand. The severity

ofpainduringvenous cannulationwasquestionedandthe

responseswererecorded.

Statisticalanalysis

Statistical analysisof datawas completedusingSPSS

ver-sion 15.0(SPSS Inc.)softwareprogram.Data aregivenas

mean±standarddeviation.Fordataanalysis,theStudent’s

ttestwasused.Significancewasacceptedasp<0.05.

Results

Theresearchwascompletedin220malepatients.The

char-acteristicsofthepatientsareshowninTable1.

The numerical rating scale (NRS) values after venous

catheterizationofGroupSweresignificantlyhigherthanthe

valuesofGroupC(p<0.01)(Table1).Whenthecorrelation

of demographicandsmokinghabitswithvenous

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Effectsofsmokingonvenouscannulationpain 49

Table1 Characteristicsofcasesincludedinthestudygroup.

Characteristic GroupC(n=110) GroupS(n=110) p

Age(year) 40.82±14.68 39.09±13.00 0.354a

Height(m) 173.15±6.82 173.86±6.80 0.441a

Weight(kg) 78.40±13.67 76.88±12.96 0.396a

Numberofcigarettepacketsperdayb _--- _1.25_±_0.56 _<0.001a

Durationofsmokinghabit(year) --- 22.37±13.39 <0.001a

NRS 1.65±1.23 3.31±1.56 <0.001a

NRS,numericalratingscale.

a _Student’s_t_test.

b _One_packet_contains₂₀_cigarettes.

Table2 Correlationofvenouscannulationpainscoreswith demographiccharacteristicsandsmokinghabitsofcases.

Factor Correlation

coefficient

p

Numberofcigarettesperday (packet)

0.451 <0.001a

Durationofsmokinghabit

(year)

0.481 <0.001a

Age 0.118 0.082a

a _Pearson_correlation_test.

significantpositivecorrelationbetweentheNRSvalues

dur-ingvenous catheterizationwithdurationof smokinghabit

andamount ofcigarettesconsumed (p<0.001).No

signifi-cantcorrelationwasdeterminedbetweenageandpainafter

venouscatheterization(p=0.082)(Table2).

Discussion

Inourstudy evaluatingthevenous catheterizationpainin

smoker and non-smoker patients we determined that the

painscoresduetovenouscatheterizationweresignificantly

higherinsmokersthanthatofnon-smokers.

Currently smoking is a common habit that causes the

mostseriouspublichealthproblems.Smokingisknowntobe

relatedtoawiderangeofseriousdiseasesincludingheart

andveindiseases,lungdiseasesandmanytypesofcancer,

especiallylungcancer.4---7

Therehavebeenmanystudiesresearchingtheeffectof

smokingonpainperception.Previousstudieshavereported

smoking to be a risk factor for development of chronic

pain and related to high perception of pain.6,12 _It _is

emphasizedthatpainperceptionofsmokersishigherthan

non-smokers,13 _however _the _mechanism _behind _the

rela-tionship between smoking and pain has not been clearly

explained.14_Studies_reporting_that_chronic_smoking_changes

theendogenouspainmechanismsaffectingpainperception

areavailable.15 _Another_mechanism _being_debated_is _that

chronicnicotineexposureduetosmokingaffectsthe

cen-tral nervous system and asa result, changes in the pain

perceptionofsmokersoccur.14,16_Experimental_studies_have

emphasizedtheanalgesicpropertiesofnicotine.Inaddition

epidemiologicalstudiessupporttheideathatsmokingis a

riskfactorforchronicandacutepain.17

Studieshaveemphasizedthatsmokingincreasesthepain

of propofol injection. Another study reported that

nico-tinereplacement insmokersreducedthepainofpropofol

injection.7

Experimentalstudies supportthis data.Inan incisional

painmodelofratsaddictedtonicotineanddeprivedofit,

thermal andmechanic stimuli increasedthe sensitivity to

pain.5

Studies have emphasized that smoking is one of the

predictorsofsevere paininthepostoperativeperiod.18 _In

anotherstudyof520toothextractionssmokingwasreported

among the factors related to increased pain levels after

toothextraction.19 _In_smokers,_deprived_of_nicotine_in_the

postoperativeperiod,thereisanincreaseinopioid

require-mentsforpatient-controlledanalgesia.20

Venouscatheterizationisafrequentlyusedintervention

inroutinemedicalapplicationstotakebloodsamplesorto

administermedications.4,21 _In_addition_during_venous

cath-eterizationinterventionpainoccursandpreviousuntreated

painfromvenouscatheterizationincreasesanxiety during

medicalintervention,lowers thepainthresholdand

espe-cially,maycausereluctancetomedicalinterventions.4,22

Totreatvenouscatheterizationpainmanydifferent

med-icationsand methodsmaybeused.Among thesemethods

aredextrosesolutions,lidocaineprilocainecreams,

ametho-cainecream,subcutaneouslidocaineinjections,anduseof

differentcolorlights.8---11

Additionallyinstudiesevaluatingthepainofvenous

cath-eterization,methodologicalfactorsaffectingpainshouldbe

considered. For example, the menstrual cycle in women

changes the pain threshold.23,24 _Gender _differences _may

causedifferencesinpainperception.25,26_For_this_reason_we

includedonlymeninourstudy.

Previousstudieshavereportedthatageisoneofthe

fac-torsaffectingpainsensation.27---29_However_in_our_study_there

was no correlation determined between age and venous

interventionpain.

Conclusion

In conclusion, the results of this study show that

smok-inginadultmalesaffectsvenouscatheterizationpain,and

venous catheterizationpain in smokers is greater than in

non-smokers.Thus,itwillbebetterforthefuturestudieson

paintotakeintoaccountthatthesmokingstatusofpatients

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50 V.Hancietal.

Conflicts

of

interest

Theauthorsdeclarenoconflictsofinterest.

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