| Objective:To explore the relationship between OPRM1 A118G polymorphism,preoperative pain sensitivity and postoperative sufentanil analgesic effect,and provide reference for individualized postoperative pain management under genetic guidance.Methods:From August 2018 to December 2019,patients aged 18～65(ASA:I～II)under general anesthesia for lumbar spine surgery and who agreed to sufentanil analgesia after the operation were selected as the research subjects at People’s Hospital of Xinjiang Autonomous Region.The pain threshold(PT)and the pain tolerance threshold(PTT)were tested and blood samples were collected.According to the polymerase chain reaction restriction fragment length polymorphism(PCR-RFLP)technology,the results of the A118G genotype test were analyzed.There are 3 groups(group AA/group AG/group GG).Theχ~2 test was used to calculate whether the genotype distribution was consistent with the Hardy-Weinberg equilibrium.One-factor analysis of variance was used to compare clinical data and PT and PTT and the 6/24/48h sufentanil dosage for postoperative analgesia of the 3 groups of patients;repeated measures analysis of variance was used to compare the 3 groups of postoperative analgesia 6/24/48h at rest and active pain Numerical Rating Scale(NRS)and Ramsay sedation score.Theχ~2 test was used to compare the incidence of adverse reactions related to sufentanil analgesia in the 3 groups and the satisfaction rate of each group for postoperative analgesia.Results:A total of 218 patients with lumbar spine surgery were included and analyzed.They were divided into 3 groups according to the genotype results(85 cases of AA type,104 cases of type AG,and 29 cases of type GG).The frequency of allele G was 37.2%,and each genotype and allele gene distribution accorded with Hardy-Weinberg equilibrium(P>0.05).There was no difference between the three groups of patients in age,male and female proportions,BMI and ASA proportions(all P>0.05).The PT and PTT of the AA group were significantly higher than those of the AG and GG groups(1.45±0.43 vs 1.33±0.36 vs 1.27±0.27 m A and 3.05±0.59 vs 2.84±0.57 vs 2.77±0.32 m A,P<0.05).The dosage of sufentanil at 6/24/48h in the GG group was significantly higher than that in the AA and AG groups(18.7±1.9 vs 17.3±2.2 vs17.1±2.4ug and 70.1±8.4 vs 65.5±10.4 vs 65.2±9.3ug,respectively And 138.4±17.0 vs 129.3±20.7vs 128.0±18.3ug,P<0.05).There was no difference in NRS scores at rest at 6/24/48 h after analgesia between the 3 groups(P>0.05).The activity NRS scores during the 6/24/48 h postoperative analgesia in the GG group were significantly higher than those in the AA and AG groups(4.28±0.75 vs 3.91±0.75 vs3.90±0.74 points and 3.83±0.60 vs 3.56±0.54 vs 3.53±0.54 points and 3.21±0.56 vs 2.93±0.57 vs 2.90±0.58points,P<0.05).The Ramsay sedation scores of 6/24/48 h postoperative analgesia in the 3 groups were not statistically significant(P>0.05).There was no difference in the incidence of postoperative analgesia-related adverse reactions among the three groups(P>0.05).The satisfaction rates of postoperative analgesia in the AA,AG and GG groups were 62.53%,60.58%and 27.59%respectively;the GG group was significantly lower than the AA and AG groups(P<0.05).Conclusion:(1)The frequency of the G allele in patients who underwent lumbar spine surgery in this study was 37.2%.(2)OPRM1 A118G is a genetic factor that causes differences in individual perception of pain.The G allele increases sensitivity to painful stimuli and reduces tolerance to painful stimuli.(3)OPRM1A118G is a genetic factor that causes differences in the effectiveness of postoperative anesthetic analgesics between individuals.The GG type requires a higher dose of opioids to meet the needs of individualized postoperative analgesia. |
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