Role of CYP2D6 Polymorphisms in the Outcome of Postoperative Pain Treatment.

Abstract

OBJECTIVE:

To investigate the role of CYP2D6 phenotype in the outcome of postoperative (PO) pain (POP) treatment.

DESIGN:

Longitudinal cohort study. Open-label trial with post hoc analysis.

SETTING:

General Hospital Surgery and Recovery Units.

PATIENTS:

Ninety unrelated Caucasians submitted to abdominal/thoracic surgery.

INTERVENTIONS:

Standard multimodal POP treatment including opioids (tramadol) and nonsteroidal anti-inflammatory drugs (ketoprofen) at different dosages and infusion rates according to the predicted mild, moderate, or severe POP.

OUTCOME MEASURES:

Pain (Numeric Rating Scale-NRS) and sedation (Ramsay Sedation Scale-RSS) up to 24 hours after surgery. By genotyping 16 CYP2D6 alleles, the four CYP2D6 phenotypes poor metabolizer (PM), intermediate metabolizers (IM), extensive metabolizers (EM) and ultrarapid metabolizers (UM) were predicted.

RESULTS:

As compared with the CYP2D6-EM phenotype, in the early PO time (30 min) a higher RSS mean score in IM was observed (P = 0.035). A suggestion towards higher mean score in PM (P = 0.091) and a minor mean score in UM (P = 0.091) was also detected. No difference in the outcome of pain across the CYP2D6 phenotypes was observed.

CONCLUSIONS:

In respect to the normal CYP2D6 phenotype, our results suggested that slowly metabolizers (IMs and PMs) might have a major sedation, whereas more rapid metabolizers (UM) a minor sedation, in the early time after surgery. A minor role of CYP2D6 phenotype in PO analgesia may be suggested.

• Authors: Davide Seripa, Paola Latina, Andrea Fontana, Carolina Gravina, Monia Lattanzi, Maria Savino, Antonietta P Gallo, Giuseppe Melchionda, Stefano A Santini, Maurizio Margaglione, Massimiliano Copetti, Lazzaro di Mauro, Francesco Panza, Antonio Greco, Alberto Pilotto
• Journal: Pain medicine (Malden, Mass.) (Pain Med) Vol. 16 Issue 10 Pg. 2012-23 (Oct 2015) ISSN: 1526-4637 [Electronic] England
• PMID: 25989235 (Publication Type: Clinical Trial, Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Wiley Periodicals, Inc.

Chemical References

• Analgesics
• Genetic Markers
• Cytochrome P-450 CYP2D6

Topics

• Adult
• Aged
• Aged, 80 and over
• Analgesics (therapeutic use)
• Cytochrome P-450 CYP2D6 (genetics)
• Female
• Genetic Markers (genetics)
• Genetic Predisposition to Disease (epidemiology, genetics)
• Humans
• Italy (epidemiology)
• Longitudinal Studies
• Male
• Middle Aged
• Outcome Assessment, Health Care (methods)
• Pain Measurement (statistics & numerical data)
• Pain, Postoperative (drug therapy, epidemiology, genetics)
• Polymorphism, Single Nucleotide (genetics)
• Risk Factors
• Treatment Outcome
• Young Adult