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Although nicotine has an analgesic effect, the incidence and severity of chronic pain is higher in smokers than nonsmokers. Acute pain is more intense in smokers during the perioperative period. This study evaluated whether smokers require higher doses of opioid to reduce pain when they undergo surgery.A retrospective review of 236 patients who had intravenous patient-controlled analgesia after distal gastrectomy with gastroduodenostomy between October 2013 and September 2014 was performed to analyze the difference in postoperative opioid requirements between smokers and nonsmokers. Total opioid consumption was observed from the day of operation to postoperative day 2. Patients were grouped into smokers (N=117) and nonsmokers (N=119) for comparison. Simple and multiple regression analyses were performed to identify predictors of postoperative opioid requirements.Opioid consumption by male smokers was higher than nonsmokers. Multiple regression analysis showed that age, smoking, and amount of intraoperative remifentanil were the only significant factors for postoperative opioid requirements.Our results suggest that smokers undergoing distal gastrectomy with gastroduodenostomy required more opioid than nonsmokers for postoperative pain. Old age, smoking status, and increment of remifentanil use seemed to be predictors of postoperative opioid consumption.