Department of Anesthesiology, University of Miami, Miami, Florida, USA.
Pain Med. 2013 Dec;14(12):1977-84. doi: 10.1111/pme.12226. Epub 2013 Aug 19.
ABCB1 is a major determinant of opioid bioavailability; however, no previous studies have provided positive evidence of an association between single-nucleotide polymorphisms (SNPs) of ABCB1 and opioid usage in acute pain management. The aim of this study was to test the association between the functional SNP C3435T in ABCB1 and opioid consumption in postoperative pain in patients undergoing a nephrectomy. Additionally, we explored the association between C3435T and opioid side effect.
C3435T was genotyped in 152 patients undergoing a nephrectomy. Opioid consumption and pain scores were evaluated as well. The effect of genotype on opioid consumption was modeled using a general linear mixed model.
Based on a mixed linear model, the ABCB1 three genotypes showed a statistically significant effect on opioid consumption (F = 4.20, P = 0.017). There was a statistically significant difference in opioid consumption among the ABCB1 three genotypes in the 0-6 hours (P = 0.031, 95% confidence interval [CI] CC 14.7-24.8 mg and TT 5.2-14.6 mg) and 6-12 hours (P = 0.009, 95% CI CC 5.6-13.8 mg and TT 1.2 mg-5.1 mg) postoperative period. There were no significant statistical differences in opioid consumption among the ABCB1 three genotypes in the 12-24 hours (P = 0.302) and 24-48 hours (P = 0.763) postoperative period. The TT genotype had significantly lower levels of cumulative opioid consumption compared with the CC genotype in first 24 hours after surgery (P = 0.029). No statistically significant differences among the three genotype groups were noted for postoperative pain scores or emesis medication use in the first 24 hours after surgery.
Our results demonstrate an association between the ABCB1 polymorphism (C3435T) and interindividual variations in opioid consumption in the acute postoperative period after nephrectomy. The ABCB1 polymorphism may serve as an important factor to guide acute pain therapy in postoperative patients.
ABCB1 是阿片类药物生物利用度的主要决定因素；然而，以前的研究没有提供 ABCB1 单核苷酸多态性 (SNP) 与急性疼痛管理中阿片类药物使用之间存在关联的阳性证据。本研究旨在检测 ABCB1 中的功能 SNP C3435T 与接受肾切除术的患者术后疼痛中阿片类药物使用之间的关联。此外，我们还探讨了 C3435T 与阿片类药物副作用之间的关联。
对 152 例接受肾切除术的患者进行 C3435T 基因分型。还评估了阿片类药物的消耗和疼痛评分。使用一般线性混合模型对基因型对阿片类药物消耗的影响进行建模。
基于混合线性模型，ABCB1 的三种基因型对阿片类药物消耗有统计学显著影响（F=4.20，P=0.017）。在 0-6 小时（P=0.031，95%置信区间 [CI] CC 14.7-24.8mg 和 TT 5.2-14.6mg）和 6-12 小时（P=0.009，95%CI CC 5.6-13.8mg 和 TT 1.2mg-5.1mg）术后期间，ABCB1 的三种基因型在阿片类药物消耗方面存在统计学显著差异。在 12-24 小时（P=0.302）和 24-48 小时（P=0.763）术后期间，ABCB1 的三种基因型在阿片类药物消耗方面没有统计学显著差异。与 CC 基因型相比，TT 基因型在术后 24 小时内的累积阿片类药物消耗明显较低（P=0.029）。在术后 24 小时内，三个基因型组在术后疼痛评分或止吐药物使用方面没有统计学显著差异。
我们的结果表明，ABCB1 多态性（C3435T）与肾切除术后急性术后期间阿片类药物消耗的个体间差异之间存在关联。ABCB1 多态性可能是指导术后患者急性疼痛治疗的重要因素。
