Cytochrome P4503A4 gene polymorphisms guide safe sufentanil analgesic doses in pregnant Chinese mothers: a multicenter, randomized, prospective study.
Female
Humans
Infant, Newborn
Pregnancy
Analgesia, Epidural
/ methods
Analgesics
/ administration & dosage
Analgesics, Opioid
/ administration & dosage
Anesthetics, Local
/ administration & dosage
Double-Blind Method
East Asian People
Polymorphism, Genetic
Prospective Studies
Ropivacaine
/ administration & dosage
Sufentanil
/ administration & dosage
Cytochrome P-450 CYP3A
/ genetics
Journal
Pharmacogenetics and genomics
ISSN: 1744-6880
Titre abrégé: Pharmacogenet Genomics
Pays: United States
ID NLM: 101231005
Informations de publication
Date de publication:
01 Jan 2024
01 Jan 2024
Historique:
medline:
16
11
2023
pubmed:
14
11
2023
entrez:
14
11
2023
Statut:
ppublish
Résumé
Sufentanil and ropivacaine when used as epidural anesthetics effectively reduce maternal pain during labor. From previous reports, rs2242480 single nucleotide polymorphisms (SNPs) can alter sufentanil metabolism, which affects analgesic efficacy. We randomly divided 573 eligible mothers into groups A and B (in a 1 : 3 ratio). The control group (group A) was given sufentanil at the usual 0.5 mg/L-1 dose + 0.15% ropivacaine hydrochloride mixture in 10 ml. The sufentanil dose given to the intervention group (group B) was determined by genotype: the GA and AA genotype group (group B1) was given 87.6% (design based on previous study results) of the usual sufentanil clinical dose (0.438 mg/L-1 sufentanil + 0.15% ropivacaine hydrochloride mixture in 10 ml) and the GG genotype group (group B2) was given the same dose as group A. Efficacy indicators consisting of maternal vital signs, obstetric transfer, neonatal prognostic indicators, and adverse effects were recorded before and after analgesia across groups. Visual analog scale scores after analgesia across groups were significantly different from scores before analgesia, showing that analgesic effects across groups were effective. No significant differences were observed in efficacy, obstetric transfer, and neonatal prognosis indicators between groups. In comparison to groups B1 and B2, group A showed more markedly suppressed cardiovascular and respiratory effects, and also a higher incidence of negative side effects such as vomiting and urinary retention. We confirmed that individualizing sufentanil doses based on maternal genotypes increased safety and success rates for women during childbirth.
Sections du résumé
BACKGROUND
BACKGROUND
Sufentanil and ropivacaine when used as epidural anesthetics effectively reduce maternal pain during labor. From previous reports, rs2242480 single nucleotide polymorphisms (SNPs) can alter sufentanil metabolism, which affects analgesic efficacy.
METHODS
METHODS
We randomly divided 573 eligible mothers into groups A and B (in a 1 : 3 ratio). The control group (group A) was given sufentanil at the usual 0.5 mg/L-1 dose + 0.15% ropivacaine hydrochloride mixture in 10 ml. The sufentanil dose given to the intervention group (group B) was determined by genotype: the GA and AA genotype group (group B1) was given 87.6% (design based on previous study results) of the usual sufentanil clinical dose (0.438 mg/L-1 sufentanil + 0.15% ropivacaine hydrochloride mixture in 10 ml) and the GG genotype group (group B2) was given the same dose as group A. Efficacy indicators consisting of maternal vital signs, obstetric transfer, neonatal prognostic indicators, and adverse effects were recorded before and after analgesia across groups.
RESULTS
RESULTS
Visual analog scale scores after analgesia across groups were significantly different from scores before analgesia, showing that analgesic effects across groups were effective. No significant differences were observed in efficacy, obstetric transfer, and neonatal prognosis indicators between groups. In comparison to groups B1 and B2, group A showed more markedly suppressed cardiovascular and respiratory effects, and also a higher incidence of negative side effects such as vomiting and urinary retention.
CONCLUSION
CONCLUSIONS
We confirmed that individualizing sufentanil doses based on maternal genotypes increased safety and success rates for women during childbirth.
Identifiants
pubmed: 37962984
doi: 10.1097/FPC.0000000000000513
pii: 01213011-202401000-00002
doi:
Substances chimiques
Analgesics
0
Analgesics, Opioid
0
Anesthetics, Local
0
Ropivacaine
7IO5LYA57N
Sufentanil
AFE2YW0IIZ
CYP3A4 protein, human
EC 1.14.14.55
Cytochrome P-450 CYP3A
EC 1.14.14.1
Types de publication
Randomized Controlled Trial
Multicenter Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
8-15Informations de copyright
Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.
Références
Halliday L, Nelson SM, Kearns RJ. Epidural analgesia in labor: a narrative review. Int J Gynaecol Obstet 2022; 159:356–364.
Hensley JG, Collins MR, Leezer CL. Pain management in obstetrics. Crit Care Nurs Clin North Am 2017; 29:471–485.
Mao L, Zhang X, Zhu J, Chen D. Analgesic effects, birth process, and prognosis of pregnant women in normal labor by epidural analgesia using sufentanil in combination with ropivacaine: a retrospective cohort study. Comput Intell Neurosci 2022; 2022:1–9.
Gosselin P, Chabot K, Beland M, Goulet-Gervais L, Morin AJ. Fear of childbirth among nulliparous women: Relations with pain during delivery, post-traumatic stress symptoms, and postpartum depressive symptoms. Encephale 2016; 42:191–196.
Huang H, Wang S, Lin R, He Z. Sufentanil for spinal analgesia during cesarean section delivery: a systematic review and meta-analysis of randomized controlled trials. Int J Clin Pract 2022; 2022:4741141.
Schrock SD, Harraway-Smith C. Labor analgesia. Am Fam Physician 2012; 85:447–454.
Chen XR, Gao T, Zhang Y, Peng MQ. Addition of low-dose sufentanil to ropivacaine for reducing shivering and visceral traction pain during cesarean section. J Int Med Res 2021; 49:3000605211017000.
Zhang L, Xu C, Li Y. Impact of epidural labor analgesia using sufentanil combined with low-concentration ropivacaine on maternal and neonatal outcomes: a retrospective cohort study. BMC Anesthesiol 2021; 21:229.
Tornio A, Backman JT. Cytochrome P450 in Pharmacogenetics: An Update. Adv Pharmacol 2018; 83:3–32.
Burk O, Wojnowski L. Cytochrome P450 3A and their regulation. Naunyn Schmiedebergs Arch Pharmacol 2004; 369:105–124.
Werk AN, Cascorbi I. Functional gene variants of CYP3A4. Clin Pharmacol Ther 2014; 96:340–348.
Zhou Q, Yu X, Shu C, Cai Y, Gong W, Wang X, et al. Analysis of CYP3A4 genetic polymorphisms in Han Chinese. J Hum Genet 2011; 56:415–422.
Fukushima-Uesaka H, Saito Y, Watanabe H, Shiseki K, Saeki M, Nakamura T, et al. Haplotypes of CYP3A4 and their close linkage with CYP3A5 haplotypes in a Japanese population. Hum Mutat 2004; 23:100.
Hu GX, Dai DP, Wang H, Huang XX, Zhou XY, Cai J, et al. Systematic screening for CYP3A4 genetic polymorphisms in a Han Chinese population. Pharmacogenomics 2017; 18:369–379.
Du J, Xing Q, Xu L, Xu M, Shu A, Shi Y, et al. Systematic screening for polymorphisms in the CYP3A4 gene in the Chinese population. Pharmacogenomics 2006; 7:831–841.
Qi G, Han C, Zhou Y, Wang X. Allele and genotype frequencies of CYP3A4, CYP3A5, CYP3A7, and GSTP1 gene polymorphisms among mainland Tibetan, Mongolian, Uyghur, and Han Chinese populations. Clin Exp Pharmacol Physiol 2022; 49:219–227.
Tateishi T, Krivoruk Y, Ueng YF, Wood AJ, Guengerich FP, Wood M. Identification of human liver cytochrome P-450 3A4 as the enzyme responsible for fentanyl and sufentanil N-dealkylation. Anesth Analg 1996; 82:167–172.
Lv J, Liu F, Feng N, Sun X, Tang J, Xie L, et al. CYP3A4 gene polymorphism is correlated with individual consumption of sufentanil. Acta Anaesthesiol Scand 2018; 62:1367–1373.
Zhang H, Chen M, Wang X, Yu S. Patients with CYP3A4*1G genetic polymorphism consumed significantly lower amount of sufentanil in general anesthesia during lung resection. Medicine (Baltim) 2017; 96:e6013.
Yuan R, Zhang X, Deng Q, Wu Y, Xiang G. Impact of CYP3A4*1G polymorphism on metabolism of fentanyl in Chinese patients undergoing lower abdominal surgery. Clin Chim Acta 2011; 412:755–760.
Zhang W, Chang YZ, Kan QC, Zhang LR, Li ZS, Lu H, et al. CYP3A4*1G genetic polymorphism influences CYP3A activity and response to fentanyl in Chinese gynecologic patients. Eur J Clin Pharmacol 2010; 66:61–66.
Collins JM, Wang D. Regulation of CYP3A4 and CYP3A5 by a lncRNA: a potential underlying mechanism explaining the association between CYP3A4*1G and CYP3A metabolism. Pharmacogenet Genomics 2022; 32:16–23.
Halliday L, Kinsella M, Shaw M, Cheyne J, Nelson SM, Kearns RJ. Comparison of ultra-low, low and high concentration local anaesthetic for labour epidural analgesia: a systematic review and network meta-analysis. Anaesthesia 2022; 77:910–918.
Wong AK, Somogyi AA, Rubio J, Philip J. The role of pharmacogenomics in opioid prescribing. Curr Treat Options Oncol 2022; 23:1353–1369.
Yuan JJ, Hou JK, Zhang W, Chang YZ, Li ZS, Wang ZY, et al. CYP3A4 * 1G Genetic polymorphism influences metabolism of fentanyl in human liver microsomes in Chinese patients. Pharmacology 2015; 96:55–60.
Chi LQ, Lu X, Wang L, Liu SP, Ding N, Zhang HY, et al. Detection of cytochrome P450 3A4 gene polymorphism guides for labor analgesia with sufentanil medication. Beijing Da Xue Xue Bao 2015; 47:653–656.
Dong ZL, Li H, Chen QX, Hu Y, Wu SJ, Tang LY, et al. Effect of CYP3A4*1G on the fentanyl consumption for intravenous patient-controlled analgesia after total abdominal hysterectomy in Chinese Han population. J Clin Pharm Ther 2012; 37:153–156.
Rivasi G, Menale S, Turrin G, Coscarelli A, Giordano A, Ungar A. The effects of pain and analgesic medications on blood pressure. Curr Hypertens Rep 2022; 24:385–394.
Kalagac Fabris L. Pro and contra on adjuvants to neuroaxial anesthesia and peripheral nerve blocks. Acta clinica Croatica 2022; 61(Suppl 2):57–66.
Fonseca NM, Guimarães GMN, Pontes JPJ, Azi L, de Ávila Oliveira R. Safety and effectiveness of adding fentanyl or sufentanil to spinal anesthesia: systematic review and meta-analysis of randomized controlled trials. Braz J Anesthesiol 2023; 73:198–216.
Ohel G, Gonen R, Vaida S, Barak S, Gaitini L. Early versus late initiation of epidural analgesia in labor: does it increase the risk of cesarean section? a randomized trial. Am J Obstet Gynecol 2006; 194:600–605.
Baczek G, Rychlewicz S, Sys D, Teliga-Czajkowska J. Epidural anesthesia during childbirth - retrospective analysis of maternal and neonatal results. Ginekol Pol 2022; 93:847–855.
Srebnik N, Barkan O, Rottenstreich M, Ioscovich A, Farkash R, Rotshenker-Olshinka K, et al. The impact of epidural analgesia on the mode of delivery in nulliparous women that attain the second stage of labor. J Matern Fetal Neonatal Med 2020; 33:2451–2458.
Anim-Somuah M, Smyth RM, Cyna AM, Cuthbert A. Epidural versus non-epidural or no analgesia for pain management in labour. Cochrane Database Syst Rev 2018; 5:CD000331.
Bates RG, Helm CW, Duncan A, Edmonds DK. Uterine activity in the second stage of labour and the effect of epidural analgesia. Br J Obstet Gynaecol 1985; 92:1246–1250.
Altman M, Sandström A, Petersson G, Frisell T, Cnattingius S, Stephansson O. Prolonged second stage of labor is associated with low Apgar score. Eur J Epidemiol 2015; 30:1209–1215.
Gehling M, Tryba M. Risks and side-effects of intrathecal morphine combined with spinal anaesthesia: a meta-analysis. Anaesthesia 2009; 64:643–651.
Seki H, Shiga T, Mihara T, Hoshijima H, Hosokawa Y, Hyuga S, et al. Effects of intrathecal opioids on cesarean section: a systematic review and Bayesian network meta-analysis of randomized controlled trials. J Anesth 2021; 35:911–927.
Salem IC, Fukushima FB, Nakamura G, Ferrari F, Navarro LC, Castiglia YM, et al. Side effects of subarachnoid and epidural sufentanil associated with a local anesthetic in patients undergoing labor analgesia. Rev Bras Anestesiol 2007; 57:125–135.
dbSNP database [database online]. NCBI and the National Human Genome Research Institute (NHGRI); 1999. Update September 21, 2022.
Zhao Z, Lv B, Zhao X, Zhang Y. Effects of OPRM1 and ABCB1 gene polymorphisms on the analgesic effect and dose of sufentanil after thoracoscopic-assisted radical resection of lung cancer. Biosci Rep 2019; 39:BSR20181211.