CYP2D6 Poor Metabolizer Genotype and Smoking Predict Severe Postoperative Pain in Female Patients on Arrival to the Recovery Room

Yang, Zhenshan; Yang, Zhe; Arheart, Kristopher L.; Morris, Richard; Zhang, Yanping; Rodriguez, Yiliam; Song, Chun-yu; Gitlin, Melvin C.; Candiotti, Keith A.

doi:10.1111/j.1526-4637.2012.01296.x

Cited by 31 publications

(18 citation statements)

References 22 publications

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“…Most researchers have reported no significant difference in incidence of PONV between EMs and PMs (Candiotti et al, 2005; Janicki, Schuler, Jarzembowski, & Rossi, 2006). In one recent study, however, Yang and colleagues (2012) reported the occurrence of severe postoperative pain was significantly higher in PMs as compared to the other metabolizer groups, requiring higher doses of opioids for pain relief.…”

Section: Discussionmentioning

confidence: 90%

“…Ultrametabolizers (UMs) are the result of a copy number variant (extra genes), resulting in increased metabolic capacity (Arneth et al, 2009). UMs usually require less opioids in the postoperative period compared to the other groups due to enhanced metabolic activity (Yang, et al, 2012), yet they are also at risk of intense adverse events from this more rapid metabolism (Leppert, 2011). …”

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confidence: 99%

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The Association of CYP2D6 Genotype and Postoperative Nausea and Vomiting in Orthopedic Trauma Patients

Wesmiller

Henker

Sereika

et al. 2012

Biological Research For Nursing

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The CYP2D6 gene encodes for an enzyme that is involved in the metabolism of more than 25% of all medications, including many opioids and antiemetics. It may contribute to the risk of postoperative nausea and vomiting (PONV), a common surgical complication. However, little research has been conducted in this area. The purpose of this study was to explore the association of CYP2D6 genotypes with PONV in adult surgical trauma patients. Data from 112 patients (28% female) with single extremity fractures, aged 18–70 years, were analyzed. PONV was defined as present if patients reported nausea, were observed vomiting, or received medication for PONV. Saliva samples collected for DNA extraction and Taqman®allele discrimination and quantitative real time polymerase chain reaction (qRT-PCR) were used to collect genotype data that were then used to assign CYP2D6 phenotype classification. The incidence of PONV was 38% in the postanesthesia care unit and increased to 50% when assessed at 48 hr. CYP2D6 classification results were 7 (6%) poor metabolizers, 34 (30%) intermediate metabolizers, and 71 (63%) extensive metabolizers. No ultrarapid metabolizers were identified. Patients who were classified as poor metabolizers had less PONV and higher pain scores. Gender and history of PONV, but not smoking, were also significant risk factors. Findings suggest variability in CYP2D6 impacts susceptibility to PONV.

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Section: Discussionmentioning

confidence: 90%

mentioning

confidence: 99%

The Association of CYP2D6 Genotype and Postoperative Nausea and Vomiting in Orthopedic Trauma Patients

Wesmiller

Henker

Sereika

et al. 2012

Biological Research For Nursing

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“…For opioid metabolism, the relationship of pain and polymorphisms of cytochrome P450 enzymes (CYP2D6, CYP2B6, and CYP3A4) are well documented [83]. In a study by Yang et al [84], 71 % of postoperative patients with acute severe pain had the CYP2D6 poor metabolizer genotype. In a separate analysis, ultrametabolizers for CYP2D6 also demonstrated higher efficiency in synthesizing endogenous morphine compared to other CYP metabolizer groups and required significantly less morphine in the postoperative period [85].…”

Section: Genetics Of Cpspmentioning

confidence: 99%

Preventive Analgesia and Novel Strategies for the Prevention of Chronic Post-Surgical Pain

Clarke

Poon

Weinrib

et al. 2015

Drugs

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Chronic post-surgical pain (CPSP) is a serious complication of major surgery that can impair a patient's quality of life. The development of CPSP is a complex process which involves biologic, psychosocial, and environmental mechanisms that have yet to be fully understood. Currently perioperative pharmacologic interventions aim to suppress and prevent sensitization with the aim of reducing pain and analgesic requirement in acute as well as long-term pain . Despite the detrimental effects of CPSP on patients, the body of literature focused on treatment strategies to reduce CPSP remains limited and continues to be understudied. This article reviews the main pharmacologic candidates for the treatment of CPSP, discusses the future of preventive analgesia, and considers novel strategies to help treat acute postoperative pain and lessen the risk that it becomes chronic. In addition, this article highlights important areas of focus for clinical practice including: multimodal management of CPSP patients, psychological modifiers of the pain experience, and the development of a Transitional Pain Service specifically designed to manage patients at high risk of developing chronic post-surgical pain. Key PointsThe development of chronic post-surgical pain (CPSP) is a complex process which involves biologic, psychosocial, and environmental mechanisms.Ketamine (an NMDA antagonist) appears to be the pharmacologic agent with the most consistent positive preventive analgesic results.The variation in patient response to pharmacologic agents can be explained, in part, by genetic polymorphisms.Understanding the heritability of CPSP will be useful when developing predictive algorithms to determine the preoperative risk for developing CPSP.Psychological treatments delivered before and after surgery have the potential to influence the trajectory of CPSP from the earliest days, in combination with multimodal, preventive analgesia.

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“…5 Estudos enfatizaram que o tabagismo é um dos preditivos de dor intensa no período pós-operatório. 18 Em outro estudo, no qual 520 extrações dentárias foram feitas, o tabagismo foi relatado entre os fatores relacionados ao aumento dos níveis de dor após a extração do dente. 19 Em fumantes, privados de nicotina no período pós-operatório, houve um aumento da necessidade de opiáceos para analgesia controlada pelo paciente.…”

Section: Discussionunclassified

Efeitos do tabagismo sobre a dor durante o cateterismo venoso: um estudo prospectivo e randomizado

Hancı

Kiraz

Ömür

et al. 2015

Brazilian Journal of Anesthesiology

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CYP2D6 Poor Metabolizer Genotype and Smoking Predict Severe Postoperative Pain in Female Patients on Arrival to the Recovery Room

Abstract: This study demonstrated that female patients possessing the PM genotype of CYP2D6 and patients who smoke had a higher incidence of acute severe postoperative pain.

Cited by 31 publications

References 22 publications

The Association of CYP2D6 Genotype and Postoperative Nausea and Vomiting in Orthopedic Trauma Patients

The Association of CYP2D6 Genotype and Postoperative Nausea and Vomiting in Orthopedic Trauma Patients

Preventive Analgesia and Novel Strategies for the Prevention of Chronic Post-Surgical Pain

Efeitos do tabagismo sobre a dor durante o cateterismo venoso: um estudo prospectivo e randomizado

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