Effect of ABCB1C1236T gene polymorphism on analgesic effects of sufentanil and morphine in patients with femoral fracture after surgery

Abstract

Objective This study was aimed to investigate the impact of the ABCB1C1236T gene polymorphism on the analgesic efficacy of morphine combined with sufentanil in patients undergoing surgery for femoral fracture. Methods A total of 400 patients with femoral fracture (FF) were assigned to either the morphine group or the non-morphine group by random number table method.. Prior to surgery, 2ml of venous blood was collected from all patients for genetic testing. Intravenous analgesia pumps were used after surgery.. In the morphine group, patients received an epidural injection of morphine hydrochloride (1.5ml) at the end of surgery, while patients in the non-morphine group received 0.9% normal saline (NS) solution (1.5ml). The C1236T gene polymorphism, as well as pain, nausea, and vomiting levels on days 1, 2, 3, and 7 after surgery, were assessed in both groups. Pain duration, the number of patient-controlled analgesia (PCA) compressions, and PCA pump fluid volume were also observed. Multiple linear regression analysis was employed to identify risk factors influencing pain levels on day 1 after surgery, using numerical rating scale (NRS) as the dependent variable. Results A total of 369 patients were included, with 185 in the morphine group and 184 in the non-morphine group. In the morphine group, there were 90 cases of C/C genotype, 90 cases of C/T genotype, and 5 cases of T/T genotype. In the non-morphine group, there were 84 cases of C/C genotype, 76 cases of C/T genotype, and 24 cases of T/T genotype. The genotype frequencies in both groups conformed to the Hardy-Weinberg genetic equilibrium law. In the non-morphine group, patients with the CC genotype had lower NRS scores on day 1 compared to those with C/T and T/T genotypes (P < 0.05). No significant difference was found in NRS scores among the three genotypes in the morphine group (P > 0.05). Multiple linear regression analysis revealed that postoperative 1-day NRS scores were associated with the onset of postoperative pain and the ABCB1C1236T genotype (P < 0.05). Conclusion The ABCB1C1236T gene polymorphism is a genetic factor influencing early postoperative pain in Han patients with FF. However, epidural administration of morphine can mitigate the impact of gene mutation on early analgesia caused by sufentanil. Trial registration number：ChiCTR2300070098，the date of registration：2023-04-02