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Genetics of perioperative pain management

Packiasabapathy, Senthil; Horn, Nicole; Sadhasivam, Senthilkumar

Current Opinion in Anesthesiology: December 2018 - Volume 31 - Issue 6 - p 749–755
doi: 10.1097/ACO.0000000000000660

Purpose of review The current review will discuss the current literature on genetics of pain and analgesia, with special emphasis on perioperative setting. We will also discuss pharmacogenetics-based management guidelines, current clinical status and future perspectives.

Recent findings Recent literature suggests that the interindividual variability in pain and postoperative analgesic response is at least in part because of one's genetic make-up. Some of the well characterized polymorphisms that are associated with surgical pain and opioid-related postoperative adverse outcomes are described in catechol-O-methyl transferase, CYP2D6 and μ-opioid receptor (OPRM1), ATP-binding cassette subfamily B member 1, ABCC3, organic cation transporter 1 genes. Clinical Pharmacogenetics Implementation Consortium has put forth recommendations on CYP2D6 genotype-based opioid selection and dosing. The list of drug–gene pairs studied continue to expand.

Summary Pharmacogenetic approach marks the dawn of personalized pain medicine both in perioperative and chronic pain settings.

Department of Anesthesia, Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana, USA

Correspondence to Senthilkumar Sadhasivam, MD, MPH, Gopal Krishna Professor and Chief of Anesthesia, Department of Anesthesia, Riley Hospital for Children at Indiana University Health, RH 2835, 705 Riley Hospital Drive, Indianapolis, IN 46202, USA. Tel: +1 317 948 3845; fax: +1 317 944 0282; e-mail:

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