TY - JOUR
T1 - Impact of pharmacogenomic profiles on post-surgical pain following laparotomy for gynecologic pathology
AU - Glaser, Gretchen E.
AU - Maddy, Brandon
AU - Kumar, Amanika
AU - Ishitani, Karen
AU - Lemens, Maureen A.
AU - Hanson, Kristine
AU - Moyer, Ann M.
AU - Habermann, Elizabeth
AU - Dowdy, Sean C.
N1 - Publisher Copyright:
© 2024 Elsevier Inc.
PY - 2024/4
Y1 - 2024/4
N2 - Objectives: The aim of this prospective study was to compare perioperative opioid use in women by status of CYP2D6, a highly polymorphic pharmacogene relevant to opioid metabolism. Methods: Patients undergoing laparotomy were prospectively recruited and provided a preoperative saliva swab for a pharmacogenomic (PGx) gene panel. Postoperative opioid usage and pain scores were evaluated via chart review and a phone survey. Pharmacogenes known to be relevant to opioid metabolism were genotyped, and opioid metabolizing activity predicted by CYP2D6 genotyping. Patient and procedural factors were compared using Fisher's exact and Kruskal-Wallis tests. Results: The 96 enrolled patients were classified as ultra-rapid (N = 3, 3%), normal (58, 60%), intermediate (27, 28%), and poor (8, 8%) opioid metabolizers. There was no difference in surgical complexity across CYP2D6 categories (p = 0.61). Morphine Milligram Equivalents (MME) consumed during the first 24 h after peri-operative suite exit were significantly different between groups: ultrarapid metabolizers had the highest median MME (75, IQR 45–88) compared to the other three groups (normal metabolizers 23 [8–45], intermediate metabolizers 48 [20–63], poor metabolizers 31 [12–53], p = 0.03). Opioid requirements were clinically greater in ultrarapid metabolizers during the second 24 h and last 24 h but were statistically similar (p = 0.07). There was no difference in MME prescribed at discharge (p = 0.22) or patient satisfaction with pain control (p = 0.64) between groups. Conclusions: A positive association existed between increased CYP2D6 activity and in-hospital opioid requirements, especially in the first 24 h after surgery. This provides important information to further individualize opioid prescriptions for patients undergoing laparotomy for gynecologic pathology.
AB - Objectives: The aim of this prospective study was to compare perioperative opioid use in women by status of CYP2D6, a highly polymorphic pharmacogene relevant to opioid metabolism. Methods: Patients undergoing laparotomy were prospectively recruited and provided a preoperative saliva swab for a pharmacogenomic (PGx) gene panel. Postoperative opioid usage and pain scores were evaluated via chart review and a phone survey. Pharmacogenes known to be relevant to opioid metabolism were genotyped, and opioid metabolizing activity predicted by CYP2D6 genotyping. Patient and procedural factors were compared using Fisher's exact and Kruskal-Wallis tests. Results: The 96 enrolled patients were classified as ultra-rapid (N = 3, 3%), normal (58, 60%), intermediate (27, 28%), and poor (8, 8%) opioid metabolizers. There was no difference in surgical complexity across CYP2D6 categories (p = 0.61). Morphine Milligram Equivalents (MME) consumed during the first 24 h after peri-operative suite exit were significantly different between groups: ultrarapid metabolizers had the highest median MME (75, IQR 45–88) compared to the other three groups (normal metabolizers 23 [8–45], intermediate metabolizers 48 [20–63], poor metabolizers 31 [12–53], p = 0.03). Opioid requirements were clinically greater in ultrarapid metabolizers during the second 24 h and last 24 h but were statistically similar (p = 0.07). There was no difference in MME prescribed at discharge (p = 0.22) or patient satisfaction with pain control (p = 0.64) between groups. Conclusions: A positive association existed between increased CYP2D6 activity and in-hospital opioid requirements, especially in the first 24 h after surgery. This provides important information to further individualize opioid prescriptions for patients undergoing laparotomy for gynecologic pathology.
KW - CYP2D6
KW - Opioids
KW - Pharmacogenomics
KW - Postoperative
KW - Surgery
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U2 - 10.1016/j.ygyno.2024.03.001
DO - 10.1016/j.ygyno.2024.03.001
M3 - Article
C2 - 38479169
AN - SCOPUS:85187563371
SN - 0090-8258
VL - 183
SP - 9
EP - 14
JO - Gynecologic oncology
JF - Gynecologic oncology
ER -