CYP2D6 gene polymorphisms influence postoperative pain sensitivity and drug response in lung cancer surgery

To investigate the role of CYP2D6 gene polymorphism expression in postoperative pain sensitivity and individualized drug response in lung cancer patients undergoing thoracoscopic surgery.

Sixty patients (aged 40-80 years, ASA I-III) undergoing thoracoscopic lung surgery between January 2024 and March 2025 were enrolled. Preoperative blood samples were collected to assess CYP2D6 gene expression. Based on enzyme activity, patients were divided into two groups: Group I (high CYP2D6 expression, n=30) and Group II (low expression, n=30). All patients received standardized anesthesia and postoperative analgesia with tramadol. Evaluated outcomes included: CYP2D6 gene activity; pain scores at 2, 4, 6, 8, and 10 hours postoperatively (VAS); PCA pump usage; ST-T segment changes on ECG; incidence of adverse events (sweating, nausea, vomiting, urinary retention); time to first cough and ambulation; and length of hospital stay.

Group I showed significantly higher CYP2D6 expression (P<0.01). Postoperative VAS scores and PCA usage (T2-T5) were significantly greater in Group I (P<0.01). ST-T changes were more pronounced in Group I at T2 and T5 (P<0.01). Group II had a higher incidence of adverse reactions (P<0.05) but demonstrated earlier coughing, earlier ambulation, and shorter hospital stays (P<0.01). No significant differences in age, weight, height, BMI, or surgical time were observed.

Patients with low CYP2D6 activity experienced stronger and longer analgesic effects after surgery. CYP2D6 genotyping may support personalized pain management in lung cancer surgery, promoting enhanced recovery (ERAS) and reduced hospital burden.