Date of this Version

11-13-2025

Document Type

DNP Project

Rights

default

Abstract

Background: The opioid epidemic has led nurse anesthetists to adopt opioid-sparing anesthesia techniques, with regional anesthesia being a key strategy for perioperative pain management. Active smoking status may complicate anesthesia planning due to its systemic effects such as altered local anesthetic metabolism and increased pain sensitivity. Smokers are at risk of under-controlled pain, may have higher analgesic requirements, and may experience potential delays in sensory blockade onset and duration. Despite smoking's known impact on cardiovascular and respiratory systems, its influence on the efficacy of regional anesthesia is not fully understood. This project aimed to address this knowledge gap by examining how active smoking status, compared to non-smoking status, affects pain perception, postoperative analgesic requirements, and local anesthetic blockade in adult surgical patients. Understanding these differences may optimize perioperative pain management and improve recovery outcomes for smokers.

Methods: A review of literature was conducted to evaluate the effects of active smoking versus non-smoking status on postoperative pain severity, analgesia requirements, and regional/neuraxial block efficacy in adult surgical patients. Peer-reviewed studies published between 2014 and 2023, focusing on human subjects, were included. Keywords such as “postoperative pain,” “analgesia requirements,” “smoking status,” and “surgical patients” were combined with Boolean operators and MeSH terms to refine the search. Inclusion criteria required studies to examine smoking’s impact on pain, analgesia, or local anesthetic blockade in adults undergoing surgery. Seventeen articles were initially retrieved, with 9 meeting final inclusion criteria after relevance screening. Exclusion criteria included pediatric populations, smoking of substances other than tobacco, and non-surgical contexts.

Results: A total of 10 CRNAs completed both the pre- and post-test assessments. Post-intervention results demonstrated improved knowledge across several key areas. Some questions remained divided post-intervention, indicating areas for further clarification. Overall, findings suggest the educational intervention was effective in increasing awareness of the complex relationship between smoking, pain, and anesthetic response.

Discussion: Post-test results showed improved CRNA knowledge of how smoking impacts pain modulation, opioid metabolism, and local anesthetic requirements. Correct responses increased for key questions; however, some questions remained split, suggesting areas needing clearer instruction. Results support prior literature on smokers’ increased analgesic needs and altered anesthetic response. Limitations include a small sample size (N = 10), potential response bias, and lack of a control group, limiting generalizability and internal validity. Despite these, findings suggest the educational intervention is a useful and scalable tool to enhance CRNA clinical knowledge regarding smoking-related anesthetic considerations.

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