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Background:Smoking behavior alters the analgesic threshold, which challenges postoperative pain management for patients who smoke.

Objectives:We aimed to assess the analgesic efficacy of tramadol versus sufentanil in relieving postoperative pain for patients who do and do not smoke who underwent a partial hepatectomy.

Study design:Double-blinded randomized controlled trial.

Setting:Eastern Hepatobiliary Surgery Hospital, Shanghai, China.

Methods:All patients in this study were men. A total of 66 patients who smoke were randomly assigned to receive tramadol or sufentanil (n = 33 each). In addition, a total of 66 patients who do not smoke were randomly assigned to receive tramadol or sufentanil (n = 33 each). The primary outcome was the consumption of additional analgesics within the first 48 hours to control postoperative pain. Secondary outcomes included the postoperative pain level, the frequency of postoperative nausea and vomiting, the sedation score, and the frequency of fever within 48 hours postsurgery.

Results:A significant interaction between "analgesic strategy" and "smoking history" was detected on the consumption of additional analgesics. In those who smoke, the requests for additional doses of analgesics were significantly less in those receiving tramadol than those receiving sufentanil; such a difference was not observed in those who do not smoke. The postoperative pain level was not significantly different between the tramadol group and the sufentanil group within patients who smoke within 48 hours postsurgery. The incidence of treatment-related adverse events was not significantly different between the tramadol group and the sufentanil group within both those who do and do not smoke.

Limitations:Only men patients were included. Also, the superior analgesic effect and the incidence of adverse events of tramadol in patients who smoke were only assessed within the first 48 hours postsurgery.

Conclusions:Our data suggest that tramadol has a better analgesic effect than sufentanil in relieving postoperative pain in patients who smoke.