What question did this study set out to answer?

The study aims to evaluate the impact of pharmacogenomic guided analgesic selection on postoperative pain management.

March 26, 2026

163: Effect of Pharmacogenomic Genes on Patient-Reported Postoperative Pain

Key Points

The study aims to evaluate the impact of pharmacogenomic guided analgesic selection on postoperative pain management.
Adult patients undergoing cardiac surgery at Cleveland Clinic were included.
Patients received IV fentanyl intraoperatively and a second opioid.
Participants were grouped based on pharmacogenomic phenotypes: group A (better metabolizers) and group B (poorer metabolizers).
Pain management effectiveness was measured using time-weighted average pain scores and opioid consumption.
Group A showed a median opioid consumption of 122 mg compared to 96 mg in group B.
Average pain scores were similar, 2.86 for group A and 2.81 for group B.
A higher percentage of group A patients utilized non-opioid medications (42%) versus group B (37%).
Group A displayed a trend toward needing more opioids compared to group B, particularly linked to OPRM1 variants.

Abstract

Introduction: This study assesses impact of pharmacogenomic (PGx) guided selection of analgesics following cardiac surgery and association between specific pharmacogenes and analgesics. This study focuses on pharmacogenes having initial evidence to support implementation in clinical care. Methods: Population of adult patients undergoing cardiac surgery at Cleveland Clinic receiving IV fentanyl intraoperatively and second opioid. Objective assesses association between post-op pain management and phenotypes of pharmacogenomics genes: CYP2D6 and OPRM1. Patients categorized into group A and B based on phenotypes. Group A expected better pain management vs Group B. Effectiveness measured by (1) time weighted average and VAS pain score; (2) opioid consumption (morphine equivalents); (3) alternatives, in first and second 24-hours postoperatively. More effective pain management defined as noninferiority in TWA pain scores, opioid use, and use of alternatives. Results: CYP2D6: First 48 hours postoperatively, cumulative opioid consumption median IQR of 122 mg 71, 184 group A (ultra-rapid/normal metabolizer) vs 96 mg 56, 174 group B (intermediate/poor metabolizer) (ratio of geometric means (97.5% CI of noninferiority test): 1.14 (0.83, 1.58), P=0.268). Average pain score 2.86 (SD 1.59) group A vs 2.81 (SD 1.60) group B (difference in means (97.5% CI of noninferiority test): 0.05 (-0.29, 0.40), P< 0.001). 71 patients (42%) group A consumed non-opioid pain medications, vs 49 patients (37%) in group B (OR (97.5% CI of noninferiority test): 1.05 (0.94, 1.16), P=0.002). OPRM1: First 48 hours group A compared to 121 mg 71, 193 group B (ratio of geometric means (97.5% CI of noninferiority test): 0.89 (0.63, 1.25), P=0.012). Avg pain score 2.77 (SD 1.56) in group A vs 3.00 (SD 1.59) in group B (difference in means (97.5% CI of noninferiority test): -0.26 (-0.64, 0.11), P< 0.001). 94 patients (38%) group A consumed non-opioid medications, vs 35 patients (43%) in group B (OR (97.5% CI of noninferiority test): 0.98 (0.87, 1.10), P< 0.001). Conclusions: This interim analysis demonstrated a trend towards increasing requirement for both opioid consumption in those who carry an OPRM1 variant or in the CYP2D6 group A phenotype (ultra-rapid/normal metabolizer) versus group B phenotype (intermediate/poor metabolizer).

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163: Effect of Pharmacogenomic Genes on Patient-Reported Postoperative Pain

Key Points

Abstract

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