IL-1β-511基因多态性与妇科手术患者电刺激痛觉敏感性的关系

目的探讨IL-1β-511基因多态性与妇科手术患者术前痛阈及耐痛阈的关系。方法择期腹式子宫全切或子宫肌瘤剔除术患者250例,年龄20~50岁,ASAⅠ或Ⅱ级。术前应用电刺激仪进行痛阈及耐痛阈测定,采用聚合酶链反应-限制性片断长度多态性技术(PCR-RFLP)进行IL-1β-511基因多态性位点检测,根据基因型将患者分为三组:C/C组(野生纯合子组),C/T组(杂合子组),T/T组(突变型纯合子组)。结果共208例患者检测出基因型,其中C/C组54例,C/T组107例,T/T组47例,三组痛阈和耐痛阈组间差异无统计学意义。结论 IL-1β-511基因多态性不影响妇科患者电刺激痛觉敏感性。     

μ阿片受体基因A118G多态性对患者电刺激痛觉敏感性的影响

目的探讨μ阿片受体基因A118G(OPRM1A118G)多态性对手术患者电刺激痛觉敏感性的影响。方法择期拟行腹部手术患者162例,ASAⅠ或Ⅱ级,男72例,女90例。采用电刺激测定患者痛阈和耐痛阈。采用聚合酶链反应-限制性片段长度多态性技术(PCR-RFLP)进行OPRM1A118G多态性位点的检测。结果共三种基因型:野生型纯合子(A/A)79例(男31例,女48例),突变型杂合子(A/G)64例(男34例,女30例),突变型纯合子(G/G)19例(男7例,女12例)。G等位基因频率为31.5%(男性33.3%,女性30.0%)。不同基因型患者年龄、BMI、痛阈和耐痛阈差异无统计学意义。不同基因型男性患者痛阈和耐痛阈均明显高于女性(P<0.05或P<0.01)。结论 OPRM1A118G等位基因突变对患者电刺激的痛阈和耐痛阈无明显影响。     

μ阿片受体A118G基因多态性对妇科手术患者疼痛敏感性的影响

目的 μ阿片受体A118G基因(OPRM1 A118G基因)多态性对妇科手术患者电刺激痛敏感性的影响.方法 择期拟行子宫肌瘤剔除术或子宫全切术患者152例,汉族,年龄20～50岁,体重指数19～21 kg/m~2,ASA Ⅰ或Ⅱ级,根据基因型分为野生型纯合子组(A/A组)、突变型杂合子组(A/G组)和突变型纯合子组(G/G组).采用电刺激测定患者痛阈和耐痛阈.使用聚合酶链反应-限制性片段长度多态性技术检测OPRM1 A118G基因多态性.结果 A/A组76例,A/G组56例,G/G组20例;G等位基因频率为31.6%.三组间痛阈差异无统计学意义(P＞0.05);G/G组耐痛阚低于A/A组和A/G组(P＜0.05);A/A组和A/G组耐痛阈差异无统计学意义(P＞0.05).结论 OPRM1 A118G基因突变可导致妇科手术患者耐痛阈降低,对痛阈无影响.     

COMTval158met基因多态性对患者术前焦虑和疼痛敏感性的影响

目的 探讨COMTval158met基因多态性对患者术前焦虑和疼痛敏感性的影响.方法 择期手术患者284例,性别不限,年龄20～ 50岁,体重指数在正常范围,ASA分级Ⅰ或Ⅱ级;另取健康志愿者28名,年龄18 ～ 25岁,体重指数在正常范围.采用苯酚-氯仿萃取法提取DNA.采用聚合酶链式反应-限制性片段长度多态性法进行COMTval158met基因多态性检测.根据患者和健康志愿者基因型分组:野生型纯合子组(G/G组)、突变型杂合子组(G/A组)和突变型纯合子组(A/A组).手术或试验前1d进行焦虑状态评分(SAI评分)和焦虑特质评分(TAI评分);患者或健康志愿者入室后平静10 min,采用电刺激仪测定痛阈与耐痛阈.结果 患者G/G组132例,G/A组110例,A/A组42例.健康志愿者G/G组12名,G/A组11名,A/A组5名.COMTval158met等位基因A突变频率为34.5％.健康志愿者3个基因组痛阈、耐痛阈、SAI评分和TAI评分比较差异无统计学意义(P＞0.05);与G/G组比较,患者A/A组痛阈、耐痛阈降低,SAI评分和TAI评分升高(P＜0.05),G/A组上述指标差异无统计学意义(P＞0.05);与健康志愿者比较,患者G/G组和G/A组SAI评分升高,A/A组痛阈、耐痛阈降低,SAI评分升高(P＜0.05).患者COMTval158met等位基因A与耐痛阈、痛阈呈负相关,与术前SAI评分呈正相关(P＜0.05).结论 COMT val158 met基因多态性与患者术前焦虑程度显著相关,以致引起患者疼痛敏感性增强.     

新疆维吾尔族老年女性疼痛患者并发焦虑抑郁与OPRM1基因多态性的相关性

目的了解新疆维吾尔族老年女性疼痛患者合并焦虑、抑郁与OPRM1基因多态性的相关性, 为新疆维吾尔族老年女性疼痛患者的治疗提供理论依据。方法采用随机数字表抽取样本, 选取年龄65～80岁门诊女性患者, 采用数字分级评分法(Numerical Rating Scale, NRS)对患者进行疼痛程度评估(将NRS评分≥1分的患者定义为疼痛患者), 纳入存在不同程度疼痛患者1 012例。采用焦虑自评量表(Self-Rating Anxiety Scale, SAS)和抑郁自评量表(Self-Rating Depression Scale, SDS)对患者进行焦虑状态和抑郁状态评定。根据SAS评分和SDS评分, 分别将患者分为焦虑组、非焦虑组, 抑郁组、非抑郁组。采用聚合酶链反应-限制性片段长度多态性(polymerase chain reaction-restriction fragment length polymorphism, PCR-RFLP)技术进行OPRM1基因多态性检测, 统计其等位基因和基因型分布频率。使用电刺激仪进行痛阈和耐痛阈的测定。记录所有患者年龄, 疼痛部位、程度(轻度...     

阿片受体A118G基因多态性与经皮穴位电刺激镇痛效应的相关性北大核心CSCD

目的探讨μ阿片受体A118G基因(OPRM1 A118G)多态性与经皮穴位电刺激(TEAS)镇痛效应的相关性。方法选择择期行腹腔镜辅助经阴子宫切除术(LAVH)患者50例,年龄18~64岁,BMI 19~28 kg/m^(2),ASAⅡ或Ⅲ级。所有患者接受全身麻醉,并于麻醉诱导前30 min于双侧足三里和三阴交穴位行TEAS,2/100 Hz疏密波、电流强度6~12 mA,直至手术结束。使用基因测序技术检测OPRM1 A118G基因多态性,根据基因型分为野生型纯合子组(AA组,n=20)、突变型杂合子组(AG组,n=25)和突变型纯合子组(GG组,n=5)。记录TEAS前即刻和刺激后30 min痛阈(PT)和耐痛阈(PTT),PT和PTT变化率,丙泊酚、顺式阿曲库铵、舒芬太尼、瑞芬太尼和总阿片类药物用量,术后2、4、6、12、24、48 h活动时VAS疼痛评分和补救镇痛情况。结果AA组20例,AG组25例,GG组5例。G等位基因频率为35%。AG组和GG组刺激前即刻PT明显低于AA组(P<0.05),刺激后30 min PT明显高于AA组(P<0.05),PT和PTT变化率明显高于AA组(P<0.05)。AG组和GG组总阿片类药物用量明显低于AA组(P<0.05),术后6、12 h AG组和GG组活动时VAS疼痛评分明显低于AA组(P<0.05)。三组刺激前即刻PTT,AG组和GG组刺激前即刻和刺激后30 min PT、PTT,AG组和GG组总阿片类药物用量,术后不同时点AG组和GG组活动时VAS疼痛评分差异无统计学意义。结论OPRM1 A118G基因突变可降低基础痛阈,但其对TEAS更敏感。TEAS的镇痛效应差异与OPRM1 A118G基因多态性有关。     

SCN9A基因多态性对胃癌术后疼痛的影响

目的 SCN9A基因单核苷酸多态性(SNPs)对胃癌手术术后患者疼痛敏感性的影响,寻找干预术后疼痛的靶点.方法 选取胃癌手术患者232例,术前进行疼痛阈值以及疼痛耐受力检测,术后进行疼痛敏感性检测并记录术后镇痛药的使用剂量.对每位患者的SCN9A基因进行SNPs检测(3312G＞T).比较SCN9A 3312G＞T和术后疼痛敏感性以及术后镇痛药使用剂量之间的关系.结果 SCN9A 3312 T的等位基因的患者有28例(12.1％),3312G的患者为204例(87.9％);术后镇痛药的给药频率[(2.78±0.75)比(2.01±0.63)小时/次,P＜0.0S]和给药量[(105.3±21.6)比(69.8±17.3) ml,P＜0.05]在3312G的患者明显高于3312T的患者;3312G组患者发生镇痛不良的概率高于3312T的患者(29.4％比8.6％,P＜0.05);回归相关分析表明SCN9A在3312位的基因改变以及疼痛阈值高与术后疼痛的敏感性有较强相关性[比值比(OR) =0.12;OR=0.29].结论 SCN9A 3312G ＞T可以降低大型手术术后患者的疼痛敏感性.     

术前定量测定舒芬太尼敏感性用于预测术后镇痛药物需要量

目的 评估术前定量测定患者对舒芬太尼的敏感程度用于预测术后镇痛药物需要量的准确性.方法 择期全麻下行直肠癌经腹前切除术男性患者50例,美国麻醉医师协会(ASA)分级Ⅰ～Ⅱ级,年龄27岁～65岁,体重指数18 kg/m2～30 kg/m2.在安静的环境下,PainVision测量患者的基础痛阈(pain threshold,PT)(PT0)、耐痛阈(pain tolerance threshold,PTT)(PTT0).面罩吸氧3 min后,靶控输注(Gepts药代动力学模型)给药舒芬太尼效应室靶浓度为0.2 μg/L,患者效应室靶浓度达到目标浓度3 min后测量PT(PT1)、PTT(PTT1).诱导后气管插管,静吸复合全麻.术毕接静脉镇痛泵.术后24 h内观察患者疼痛情况、镇痛泵有效按压次数和舒芬太尼消耗的总量. 结果 患者PT0为(47±23)μA,PTT0为(93±30) μA.靶控输注舒芬太尼效应室浓度0.2 μg/L后,PT1为(82±36) μA,PTT1为(141±42) μA.给药后的耐痛阈与24 h镇痛泵有效按压次数和镇痛泵舒芬太尼的消耗量负相关,r分别为-0.31、-0.34(P＜0.05);给药后耐痛阈的增幅与24 h镇痛泵有效按压次数和镇痛泵舒芬太尼的消耗量呈负相关,r分别为-0.89、-0.90(P＜0.05). 结论 PainVision可以定量评估患者对舒芬太尼的敏感性,给药后患者耐痛阈的增幅可作为术后患者镇痛药物需要量的主要预测指标.     

全髋关节置换术后不同镇痛方式有效性与疼痛敏感度的关系

目的探讨全髋关节置换术后不同镇痛方式有效性与疼痛敏感度之间的关系。方法2010年7月至2015年8月,解放军第180医院骨二科以中国成人股骨头坏死临床诊疗指南(2016)为诊断标准,共收治股骨头坏死患者361例,术前24 h测量疼痛敏感度(痛阈和耐痛阈)。术后共有226例获得有效镇痛,其中静脉泵持续镇痛80例,肌注中枢镇痛药62例,口服中枢镇痛药43例,口服非甾体类镇痛药41例,记录各组的痛阈区间和耐痛阈区间。以年龄、性别、体重指数、手术时间、出血量、疼痛视觉模拟评分(VAS)、痛阈和耐痛阈为评价指标,采用SPSS 19.0软件包,采用相应的单因素方差分析、卡方检验或多独立样本的秩和检验,比较各镇痛组间的差异。结果 4个镇痛组间年龄、性别、体重指数、手术时间、出血量、VAS和痛阈的差异均无统计学意义(P0.05)。口服中枢镇痛药和口服非甾体类镇痛药对应的耐痛阈差异无统计学意义(P0.05),分别为4.33 m A和4.20 m A;肌注中枢镇痛药的耐痛阈为3.60 m A,与上述两种口服镇痛药组比较差异有统计学意义(Z=17.222,P0.01;Z=16.992,P0.01);静脉泵持续镇痛的耐痛阈区间为2.90 m A,与肌注和两种口服镇痛药组比较差异有统计学意义(Z=18.747,P0.01;Z=17.403,P0.01;Z=17.162,P0.01)。结论全髋关节置换术后不同镇痛方式的有效耐痛阈不同,而与痛阈无关,术前可能可以参考有效耐痛阈,选择相应的镇痛方案。     

COMTval158met和OPRM1A118G基因多态性对患者术前疼痛敏感性的影响

目的 评价COMTval15 met和OPRM1A118G基因多态性对患者术前疼痛敏感性的影响.方法 择期妇科或普外科手术患者,无手术史,性别不限,年龄20 · 50岁,体重指数在正常范围,ASA分级Ⅰ或Ⅱ级.于术前采集外周静脉血样5 ml,采用苯酚-氯仿萃取法提取DNA,采用聚合酶链式反应-限制性片段长度多态性法进行COMTval158met和OPRM1A118G基因多态性检测.根据患者基因型联合分组,共分9组:val/val和A/A组(A1B1组)、val/met和A/A组(A2B1组)、met/met和A/A组(A3B1组)、val/val和A/G组(A1B2组)、val/met和A/G组(A2B2组)、met/met和A/G组(A3B2组)、val/val和G/G组(A1B3组)、val/met和G/G组(A2B3组)以及met/met和G/G组(A3B3组).入手术室后,采用电刺激仪测定患者痛阈和耐痛阈.结果 联合基因分型成功277例,A1B1组68例,A2B1组50例,A3B1组17例,A1B2组43例,A2B2组46例,A3B2组17例,A1B3组18例,A2B3组10例,A3B3组8例.各组患者一般情况各指标的比较差异无统计学意义(P＞0.05).OPRM1A118G和COMTval158met等位基因在国内人群中的突变率分别为32.1％和34.3％.与A1B1组比较,A2B3组和A3 B3组痛阈降低,A1B3组、A2B3组和A3B3组耐痛阈降低(P＜0.05).结论 COMTval158met和OPRM1A118G基因多态性对患者术前疼痛敏感性的影响存在交互作用.携带COMT和OPRM1基因双突变型纯合子met158met和118G的患者术前疼痛敏感性更高.     

Relationship between premature ejaculation and genetic polymorphisms of the dopamine transporter gene (SLC6A3)

What’s known on the subject? and What does the study add? The process of ejaculation is highly influenced by genetic and neurobiological factors. Central dopaminergic drugs facilitate ejaculation. Genetic variation in SLC6A3 may alter the expression of dopamine transporter gene (DAT). This study evaluated the associations between genetic polymorphisms of the DAT and PE. A statistically significant association was observed between the presence of 9‐repeat allele and 9/10 genotype and PE. The presence of 7‐repeat allele had protective effect against PE.

OBJECTIVE

? To investigate the possible relationships between premature ejaculation (PE) polymorphisms in the dopamine transporter (DAT) gene (SLC6A3, DAT1), which has a polymorphic 40 base pair (40 bp) variable number of tandem repeats (VNTR) sequence in the 3′‐untranslated region (3′ VNTR).

PATIENTS AND METHODS

? Cohorts of 270 Iranian men with PE and 266 age‐matched healthy Iranian subjects were genotyped for the DAT1‐VNTR polymorphism.

RESULTS

? The 10‐repeat allele frequencies were similar in the control (90.2%) and patient groups (88.5%) (P = 0.8). ? A statistically significant association was observed between the presence of the nine‐repeat allele and PE (chi‐squared test = 4.346, odds ratio [OR] = 2.46, 95% confidence interval [CI] = 1.57–3.15, P = 0.026). ? The frequencies of the 9/10 genotype were also significantly higher in the PE patients than in normal controls (chi‐squared test = 4.466, OR = 2.47, 95% CI = 1.52–3.21, P = 0.028). The presence of the seven‐repeat allele had a protective effect against PE (chi‐squared test = 2.324, OR = 0.62, 95% CI = 0.47–0.89, P = 0.034).

CONCLUSIONS

? The findings of the present study suggest that DAT1‐VNTR polymorphisms resulting in higher dopamine concentrations were associated with vulnerability to PE. ? Further studies are needed to replicate these results and to evaluate the role of inconsistency in the DAT genes and how this affects the development of PE.     

Opioid administration in the prehospital setting for patients sustaining traumatic injuries: An evaluation of national emergency medical services data

IntroductionDespite concerns about long-term dependence, opioids remain the mainstay of treatment for acute pain from traumatic injuries. Additionally, early pain management has been associated with improved long-term outcomes in injured patients. We sought to identify the patterns of prehospital pain management across the United States.MethodsWe used 2019 national emergency medical services (EMS) data to identify the use of pain management for acutely injured patients. Opioid specific dosing was calculated in morphine milligram equivalents (MME). The effects of opioids as well as adverse events were identified through objective patient data and structured provider documentation.ResultsWe identified a total of 3,831,768 injured patients, 85% of whom were treated by an advanced life support (ALS) unit. There were 269,281 (7.0%) patients treated with opioids, including a small number of patients intubated by EMS (n = 1537; 0.6%). The median opioid dose was 10 MME [IQR 5–10] and fentanyl was the most commonly used opioid (88.2%). Patients treated with opioids had higher initial pain scores documented by EMS than those not receiving opioids (median: 9 vs 4, p<0.001), and had a median reduction in pain score of 3 points (IQR 1–5) based on the final prehospital pain score. Adverse events associated with opioid administration, including episodes of altered mental status (n = 453; 0.2%) and respiratory compromise (n = 252; 0.1%), were rare. For patients with severe pain (≥8/10), 27.3% of patients with major injuries (ISS ≥15) were treated with opioids, compared with 24.8% of those with moderate injuries (ISS 9–14), and 21.4% of those with minor (ISS 1–8) injuries (p<0.001).ConclusionThe use of opioids in the prehospital setting significantly reduced pain among injured patients with few adverse events. Despite its efficacy and safety, the majority of patients with major injuries and severe pain do not receive opioid analgesia in the prehospital setting.     

Long-acting liposomal bupivacaine and postoperative opioid use after Peyronie’s disease surgery: a pilot study

BackgroundNovel strategies have been proposed to minimize postoperative opioid use, yet many patients experience significant pain after penile surgery. Our objective was to evaluate postoperative opioid use in patients undergoing penile ring block with long-acting liposomal bupivacaine (LB; Exparel) during surgery for Peyronie’s disease (PD).MethodsWe identified patients who underwent tunica albuginea plication (TAP) and plaque excision/grafting (PEG) for PD between July 2019 and September 2020. Intraoperatively, a ring block was administered at the penile base penis with 20 cc of LB. Patients were instructed to use over the counter pain medications as first line treatment for postoperative pain, and opioids were available for severe breakthrough pain as needed [7.5 oral morphine equivalents (OME) =5 mg oxycodone]. Opioid use was assessed during the first five days postoperatively.ResultsIn total, 28 patients met inclusion criteria including 18/28 (64%) who underwent TAP and 10/28 (36%) who underwent PEG. Median patient age was 56 years (IGR 51;61). Median postoperative 10-point visual analogue pain score was 0 (range 0–3). Duration of penile anesthesia ranged from 1.5–4 days. In total, 9/28 patients (32%) utilized opioids during the first five days postoperatively (range 7.5–75 OME). Two patients (7%) required opioids during the first two days after surgery. 27/28 (96%) were satisfied or highly satisfied with postoperative pain control.ConclusionsIntraoperative penile ring block with LB resulted in excellent pain control with local anesthetic duration of 1.5–4 days. The majority of patients did not require any opioids during the early postoperative period. Further study comparing outcomes with shorter-acting local anesthetics is necessary to balance pain control benefits with additional cost.     

Association of human μ‐opioid receptor gene polymorphism A118G with fentanyl analgesia consumption in Chinese gynaecological patients

One hundred and seventy‐four Chinese gynaecology patients were studied for the impact of A118G polymorphism in the μ‐opioid receptor gene (OPRM1) on pain sensitivity and postoperative fentanyl consumption. Pre‐operatively, the pain threshold and pain tolerance threshold were measured using electrical stimulation. A118G polymorphism was genotyped using the polymerase chain reaction–restriction fragment length polymorphism method. Intravenous fentanyl patient‐controlled analgesia provided postoperative pain management, assessed using a visual analogue scale and fentanyl consumed in the first 24 h after surgery was noted. We found the prevalence of G118 allele was 31.3%. The A118G polymorphism had a gene‐dose‐dependent effect on electrical pain tolerance threshold. Fentanyl consumption was also significantly different in patients with different OPRM1 genotypes (homozygotes for 118G consumed more than did heterozygotes or homozygotes for 118A). Fentanyl consumption increased in accordance with the number of 118G alleles. We conclude that OPRM1 gene analysis may help predict individual opioid sensitivity and so optimise postoperative pain control.     

Meta-analysis of the association of IL1-RN variable number of tandem repeats polymorphism with osteoarthritis risk

ObjectiveThe aim of this meta-analysis was to clarify the role of Interleukin-1 receptor antagonist gene (IL1-RN) Variable Number of Tandem Repeats (VNTR) polymorphism on the risk of OA by means of meta-analysis.MethodsEligible articles were retrieved from PubMed, Web of science and Google scholar with a total of 1187 OA cases and 2659 controls. The strength of the association between the IL1-RN VNTR polymorphism and the risk of OA was assessed by odds ratios (ORs) with the corresponding 95% confidence interval (CI) for each study.ResultsThe meta-analysis of seven published studies retrieved from the literature search showed a significantly increased OA risk in the recessive model analysis (22 vs 2L + LL: P^b = 0.18, I² = 32.8, OR(95% CI) = 1.50(1.12, 2.02), P = 0.007), the additive model analysis (22 vs LL: P^b = 0.08, I² = 46.8, OR(95% CI) = 1.56(1.15, 2.12), P = 0.004) and in the allele contrast model (2 vs L: P^b = 0.02, I² = 58.8, OR(95% CI) = 1.20(1.05, 1.36), P = 0.007). By subgroup analysis, the IL1-RN VNTR polymorphism was found to be significantly associated with OA susceptibility in Caucasian and Hospital based case-control study (HCC) groups.ConclusionThis meta-analysis showed that IL1-RN VNTR polymorphism may increase the susceptibility to OA. More studies with detailed information are needed to validate our conclusion.Level of evidenceLevel III, diagnostic study.     

Significant reduction of postoperative pain and opioid analgesics requirement with an Enhanced Recovery After Thoracic Surgery protocol

ObjectiveTo evaluate differences in postoperative pain control and opioids requirement in thoracic surgical patients following implementation of an Enhanced Recovery after Thoracic Surgery protocol with a comprehensive postoperative pain management strategy.Material and MethodsA retrospective analysis of a prospectively maintained database of patients undergoing pulmonary resections by robotic thoracoscopy or thoracotomy from January 1, 2017, to January 31, 2019, was conducted. Multimodal pain management strategy (opioid-sparing analgesics, infiltration of liposomal bupivacaine to intercostal spaces and surgical sites, and elimination of thoracic epidural analgesia use in thoracotomy patients) was implemented as part of Enhanced Recovery after Thoracic Surgery on February 1, 2018. Outcome metrics including patient-reported pain levels, in-hospital and postdischarge opioids use, postoperative complications, and length of stay were compared before and after protocol implementation.ResultsIn total, 310 robotic thoracoscopy and 62 thoracotomy patients met the inclusion criteria. This pain management strategy was associated with significant reduction of postoperative pain in both groups with an overall reduction of postoperative opioids requirement. Median in-hospital opioids use (morphine milligram equivalent per day) was reduced from 30 to 18.36 (P = .009) for the robotic thoracoscopy group and slightly increased from 15.48 to 21.0 (P = .27) in the thoracotomy group. More importantly, median postdischarge opioids prescribed (total morphine milligram equivalent) was significantly reduced from 480.0 to 150.0 (P < .001) and 887.5 to 150.0 (P < .001) for the thoracoscopy and thoracotomy groups, respectively. Similar short-term perioperative outcomes were observed in both groups before and following protocol implementation.ConclusionsImplementation of Enhanced Recovery after Thoracic Surgery allows safe elimination of epidural use, better pain control, and less postoperative opioids use, especially a drastic reduction of postdischarge opioid need, without adversely affecting outcomes.