Department of Anesthesiology and Pain Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Hangzhou, 310009, China.
BMC Anesthesiol. 2020 Feb 5;20(1):38. doi: 10.1186/s12871-020-0949-6.
Postoperative inadequate analgesia following video-assisted thoracoscopic surgery (VATS) is a common and significant clinical problem. While genetic polymorphisms may play role in the variability of postoperative analgesia effect, few studies have evaluated the associations between genetic mutations and inadequate analgesia after single-port VATS.
Twenty-eight single nucleotide polymorphisms (SNPs) among 18 selected genes involved in pain perception and modulation were genotyped in 198 Chinese patients undergoing single-port VATS. The primary outcome was the occurrence of inadequate analgesia in the first night and morning after surgery which was defined by a comprehensive postoperative evaluation. Multivariable logistic regression analyses were used to identify the association between genetic variations and postoperative inadequate analgesia.
The prevalence of postoperative inadequate analgesia was 45.5% in the present study. After controlling for age and education level, association with inadequate analgesia was observed in four SNPs among three genes encoding voltage-gated sodium channels. Patients with the minor allele of rs33985936 (SCN11A), rs6795970 (SCN10A), and 3312G > T (SCN9A) have an increased risk of suffering from inadequate analgesia. While the patients carrying the minor allele of rs11709492 (SCN11A) have lower risk experiencing inadequate analgesia.
We identified that SNPs in SCN9A, SCN10A, and SCN11A play a role in the postoperative inadequate analgesia after single-port VATS. Although future larger and long-term follow up studies are warranted to confirm our findings, the results of the current study may be utilized as predictors for forecasting postoperative analgesic effect for patients receiving this type of surgery.
This study was retrospectively registered in the ClinicalTrials.gov Registry (NCT03916120) on April 16, 2019.
电视辅助胸腔镜手术（VATS）后镇痛不足是一个常见且严重的临床问题。虽然遗传多态性可能在术后镇痛效果的变异性中起作用，但很少有研究评估单端口 VATS 后遗传突变与镇痛不足之间的关系。
对 198 例接受单端口 VATS 的中国患者的 18 个参与疼痛感知和调节的基因中的 28 个单核苷酸多态性（SNP）进行基因分型。主要结局是术后第一晚和早晨出现镇痛不足，这是通过综合术后评估来定义的。多变量逻辑回归分析用于确定遗传变异与术后镇痛不足之间的关联。
本研究中术后镇痛不足的发生率为 45.5%。在控制年龄和教育水平后，编码电压门控钠通道的三个基因中的四个 SNP 与镇痛不足有关。携带 rs33985936（SCN11A）、rs6795970（SCN10A）和 3312G>T（SCN9A）的次要等位基因的患者发生镇痛不足的风险增加。而携带 rs11709492（SCN11A）的次要等位基因的患者发生镇痛不足的风险较低。
我们发现 SCN9A、SCN10A 和 SCN11A 的 SNP 与单端口 VATS 后镇痛不足有关。尽管未来需要更大规模和长期随访的研究来证实我们的发现，但本研究的结果可作为预测接受此类手术患者术后镇痛效果的预测因子。
本研究于 2019 年 4 月 16 日在 ClinicalTrials.gov 注册（NCT03916120）。
