Study on individualized analgesia guided by CYP3A4/5 polymorphisms in perioperative thoracoscopic surgery

To explore the significance of CYP3A4 and CYP3A5 genetic polymorphisms in achieving personalized fentanyl application in patients undergoing thoracoscopic operation.

This was a retrospective study. One hundred patients with lung cancer received thoracoscopic surgery operation under the conditions of general anesthesia. According to the results of individualized analgesia guided by CYP3A4/5 polymorphisms, the patients were assigned into three groups: group I (the wild-type homozygote, the induced dosage of fentanyl: 6 µg/kg, the background infusion rate of patient-controlled intravenous analgesia (PCIA): 2 mL/h), group II (the heterozygote, the induced dosage of fentanyl: 5 µg/kg, the background infusion rate of PCIA: 1.5 mL/h), and group III (the mutant homozygote, the induced dosage of fentanyl: 4 µg/kg, the background infusion rate of PCIA: 1 mL/h). The locking-time was 15 min. A visual analog scale (VAS) score less than 3 points suggested effective analgesia. The times of operation and recovery were examined. Surgical plethysmography index (SPI), blood glucose levels, VAS and bruggemann comfort scale (BCS) scores at different time points were recorded, respectively. Total consumption of fentanyl, the effective time of PCIA compression, and the incidence of adverse drug reactions were also recorded.

There were no statistical differences in SPI, blood glucose level, VAS, BCS scores and incidence of adverse reactions among the three groups. In term of intraoperative, postoperative fentanyl doses and the amount of effective PCA, significant differences were found among the groups (P < 0.05).

According to the genotype of CYP3A4/CYP3A5, an individualized application of fentanyl is feasible.