Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Department of Clinical Pharmacology, University of Helsinki and Helsinki University Hospital, Finland.
Clin Pharmacol Ther. 2018 Apr;103(4):653-662. doi: 10.1002/cpt.771. Epub 2017 Aug 24.
We investigated factors affecting analgesic oxycodone concentrations after breast cancer surgery in 1,000 women. Preoperatively, we studied heat and cold pain sensitivities and anxiety scores. Postoperatively, rest and motion pain intensities were measured and intravenous oxycodone was administered until satisfactory analgesia. At this point, the mean oxycodone concentration (variation coefficient) was 33.3 ng/mL (66%) and it was 21.7 ng/mL (69%) when the patient requested oxycodone again. At both time points, the concentrations varied >100-fold between individuals. The analgesic oxycodone concentration was increased by 21.3% per motion pain intensity score on a 0-10 scale and by 22.3% if axillary clearance was performed instead of sentinel node biopsy (P < 0.001). Forty-seven women who were older and less anxious than others (P < 0.01) required no oxycodone. Anxiety, age, chronic pain, or preoperative pain sensitivity were not independently associated with the analgesic oxycodone concentration. CYP2D6 and CYP3A genotypes did not affect analgesic concentration or duration of analgesia.
我们调查了 1000 名女性乳腺癌手术后影响羟考酮镇痛浓度的因素。术前，我们研究了热痛和冷痛敏感性以及焦虑评分。术后，测量静息和运动疼痛强度，并给予静脉羟考酮，直至达到满意的镇痛效果。此时，羟考酮的平均浓度（变异系数）为 33.3ng/ml（66%），当患者再次要求羟考酮时，浓度为 21.7ng/ml（69%）。在这两个时间点，个体之间的浓度差异超过 100 倍。运动疼痛强度评分每增加 10 分，羟考酮镇痛浓度增加 21.3%，如果行腋窝清扫而不是前哨淋巴结活检，羟考酮镇痛浓度增加 22.3%（P<0.001）。47 名年龄较大且焦虑程度低于其他人的女性（P<0.01）无需使用羟考酮。焦虑、年龄、慢性疼痛或术前疼痛敏感性与羟考酮镇痛浓度无关。CYP2D6 和 CYP3A 基因型不影响镇痛浓度或镇痛持续时间。
