Background & Aims

Pediatric Pain research has been a rapidly developing field of medicine in recent years. It is noted that pain is not so much a vital parameter as a separate disease entity that should be effectively diagnosed and treated. One of the branches of research on the diagnosis and treatment of acute and inflammatory pain is research on single gene polymorphisms (SNPs) as predictors of pain severity and, as a result, increased consumption of analgesics in the perioperative period.
A potential SNP associated with differences in pain perception and opioid requirements is the SNP A118G opioid mu-receptor 1 (OPRM1).
The aim of the study is to determine whether there is a correlation between the occurrence of SNP A118G OPRM1 in pediatric patients after surgery and the severity of pain and the doses of opioid analgesics needed to control pain after extensive orthopedic surgery.

Methods

The study was conducted at the Children’s Clinical Hospital in Bialystok (Poland), The selection was random, according to the queue of applications to the hospital.
Study was conducted from 05.2022 to 04.2023, including patients scheduled for surgical correction of scoliosis referred from lower-reference centers from Poland.
Anesthesia was performed using target-controlled infusion pumps using propofol and remifentanil and BiSpectral Index monitoring.
Postoperatively we used sufentanil infusion with addition of non-opioid pain medication (paracetamol and metamizole) and if needed – additional lidocaine and ketamine was administered.
Peripheral blood samples were collected to 1.2 mL EDTA test tubes from anesthetized patients before start of the surgery. Pain intensity and sufentanil infusions rate and additional parameters were recorded after surgery.
Genotyping was performed using ready-made TaqMan™ SNP Genotyping Assays according to manufacturer protocol.

Results

Thirty-seven patients were enrolled in the study after obtaining signed informed consent. Due to the sampling error (n = 3) and missing samples due to laboratory error (n = 2), the final group included in the analysis comprised 31 patients.
A/A genotype is more frequently present than A/G genotype among studied sample of Central Europeans (p = 0.001).
The pain assessment after extubation had a median score of 4.0 in the AA group and 5.0 in the AG group. The difference was not statistically significant (p = 0.684)
The mean of drug flow rate [µg/kg/h] was slightly lower in the AG group compared to the AA group, but the p-values (p=0.790) indicated that this difference is not statistically significant.
Based on the results of the statistical analyses, there were no statistically significant differences between the AA and AG groups in terms of age, pain assessment, flow rate of the drug, length of post-anesthesia care unit stay and use of coanalgesics.

Conclusions

This study is the first to assess the possibility of using the OPRM1 A118G SNP in postoperative pain management in children undergoing major spinal fusion surgery, which obviously is an indication for postoperative opioid therapy.
Due to the selection of only patients undergoing only one type of operation, this study is not biased by patients who experienced different surgical stimuli, and only patients of Central European ancestry were studied, which could produce different results.
The strength of our study is in addressing the very important matter of pain management in children, which is not as widely discussed in the literature as in adults.
A weakness of the study is the unsatisfactory sample size.
The thesis about the influence of a SNP influence on the perception of pain was not confirmed. We believe that the key to effective pain control in children is still the individual, careful assessment of child behaviour and individual adjustment of pain medication.

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Presenting Author

Aleksander Turczynowicz

Poster Authors

Aleksander Turczynowicz

MD

Medical University of Bialystok

Lead Author

E-mail

Topics

  • Genetics