Dataset Information

A hybrid implementation-effectiveness randomized trial of CYP2D6-guided postoperative pain management.

ABSTRACT:

Purpose

Cytochrome P450 2D6 (CYP2D6) genotype-guided opioid prescribing is limited. The purpose of this type 2 hybrid implementation-effectiveness trial was to evaluate the feasibility of clinically implementing CYP2D6-guided postsurgical pain management and determine that such an approach did not worsen pain control.

Methods

Adults undergoing total joint arthroplasty were randomized 2:1 to genotype-guided or usual pain management. For participants in the genotype-guided arm with a CYP2D6 poor (PM), intermediate (IM), or ultrarapid (UM) metabolizer phenotype, recommendations were to avoid hydrocodone, tramadol, codeine, and oxycodone. The primary endpoints were feasibility metrics and opioid use; pain intensity was a secondary endpoint. Effectiveness outcomes were collected 2 weeks postsurgery.

Results

Of 282 patients approached, 260 (92%) agreed to participate. In the genotype-guided arm, 20% had a high-risk (IM/PM/UM) phenotype, of whom 72% received an alternative opioid versus 0% of usual care participants (p < 0.001). In an exploratory analysis, there was less opioid consumption (200 [104-280] vs. 230 [133-350] morphine milligram equivalents; p = 0.047) and similar pain intensity (2.6 ± 0.8 vs. 2.5 ± 0.7; p = 0.638) in the genotype-guided vs. usual care arm, respectively.

Conclusion

Implementing CYP2D6 to guide postoperative pain management is feasible and may lead to lower opioid use without compromising pain control.

SUBMITTER: Thomas CD

PROVIDER: S-EPMC8525217 | biostudies-literature | 2021 Apr

REPOSITORIES: biostudies-literature

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Publications

A hybrid implementation-effectiveness randomized trial of CYP2D6-guided postoperative pain management.

Thomas Cameron D CD Parvataneni Hari K HK Gray Chancellor F CF Deen Justin T JT Prieto Hernan A HA Pulido Luis F LF Elsey Amanda R AR Elwood Erica N EN Starostik Petr P Gong Yan Y Fillingim Roger B RB Johnson Julie A JA Cavallari Larisa H LH

Genetics in medicine : official journal of the American College of Medical Genetics 20210108 4

<h4>Purpose</h4>Cytochrome P450 2D6 (CYP2D6) genotype-guided opioid prescribing is limited. The purpose of this type 2 hybrid implementation-effectiveness trial was to evaluate the feasibility of clinically implementing CYP2D6-guided postsurgical pain management and determine that such an approach did not worsen pain control.<h4>Methods</h4>Adults undergoing total joint arthroplasty were randomized 2:1 to genotype-guided or usual pain management. For participants in the genotype-guided arm with ...[more]

PMID: 33420349

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Dataset Information

A hybrid implementation-effectiveness randomized trial of CYP2D6-guided postoperative pain management.

Purpose

Methods

Results

Conclusion

Publications

A hybrid implementation-effectiveness randomized trial of CYP2D6-guided postoperative pain management.

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