Pharmacogenetic aspects of the effectiveness of nonsteroidal anti-inflammatory drugs and opioids for postoperative pain management in patients after total joint arthroplasty
Objective: to study the possible relationship between genetic, clinical, laboratory, demographic data and the average level of pain postoperatively, the need for opioid analgesics in patients who underwent total knee or hip arthroplasty.Materials and methods. The study included 61 patients who under...
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| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | Russian |
| Published: |
IMA-PRESS LLC
2020-12-01
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| Series: | Современная ревматология |
| Subjects: | |
| Online Access: | https://mrj.ima-press.net/mrj/article/view/1733 |
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| Summary: | Objective: to study the possible relationship between genetic, clinical, laboratory, demographic data and the average level of pain postoperatively, the need for opioid analgesics in patients who underwent total knee or hip arthroplasty.Materials and methods. The study included 61 patients who underwent total knee or hip arthroplasty. Patients were prescribed NSAIDs (ketoprofen or ketorolac) postoperatively, tramadol was prescribed as needed. A numeric rating scale was used to assess pain during the first 5 days after surgery; opioid analgesics (morphine equivalents) consumption during the hospitalization was recorded. CYP2C9, CYP2C8, PTGS1, PTGS2, ABCB1, CYP2D6, OPRM1, COMT, and C3orf20 gene polymorphisms were determined by real-time PCR.Results and discussion. Patients with AС genotype of CYP2C9*3 had less severe pain on day 1 (4.5±1.0 versus 7.0±2.3 points, p=0.03), and had a lower need for opioids (20.0±11.5 versus 28.0±7.4 units of morphine equivalent, p=0.04) during the hospitalization than AA genotype carriers. Patients with CC genotype of ABCB1 rs1045642 had lower pain on day 5 compared with CT genotype carriers (1.5±0.7 vs. 3.7±1.2, p=0.04). Patients with AA genotype of OPRM1 rs1799971 required more opioids postoperatively than patients with AG+GG genotypes (21.6±9.8 vs. 28.4±7.1, p=0.03). Patients with GG genotype of C3orf20 rs12496846 had more severe pain on day 4 (6.0 ± 1.41) compared with patients with AA genotype (2.60 ± 1.50), p=0.002.Conclusion. The intensity of postoperative pain and/or the opioid analgesics consumed after knee or hip arthroplasty were associated with pharmacogenetic features of patients, namely CYP2C9, ABCB1, OPRM1, C3orf20 genotypes. |
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| ISSN: | 1996-7012 2310-158X |