eP708 - Pharmacogenomics of Perioperative Analgesia in a Colorectal Enhanced Recovery After Surgery Program

ePoster Presenter(s)

• 

  Brandon Smith, MD

  Fellow - Colon and Rectal Surgery
  Baylor University Medical Center
  Springfield, MA, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.

Senior Author(s)

• 

  Katerina O.K. Wells, MD MPH

  Colorectal Surgeon
  Baylor University Medical Center, Dallas
  Dallas, Texas, United States

  Disclosure information not submitted.

Author(s)

• RB

  Raul Benavides, MD, FCAP

  Section Director Main Laboratories
  Baylor Univ Med Ctr
  Dallas, Texas, United States

  Disclosure information not submitted.
• RS

  Rehma Shabbir, MBBS, ACRP-CP

  Surgical Research Manager
  Baylor University Medical Center
  Dallas, Texas, United States

  Disclosure information not submitted.
• EK

  Ender Karaca, MD, FACMG

  Laboratory Director
  Baylor University Medical Center, Department of Pathology
  Dallas, Texas, United States

  Disclosure information not submitted.
• JW

  Jenifer Williams, BS, CHS (ACHI), MB (ASCP)

  Manager
  Baylor Scott & White Health
  Dallas, Texas, United States

  Disclosure information not submitted.
• XW

  Xuan Wang, Phd

  Biostatistician
  Baylor research institute
  Dallas, Texas, United States

  Disclosure information not submitted.
• JS

  Juliet Smith, MB(ASCP), CHT(ACHI)

  Clinical Molecular Technologist
  Baylor Scott and White
  Dallas, Texas, United States

  Disclosure information not submitted.
• DZ

  Dora Zafrani, MB(ASCP)

  Clinical Molecular Technologist
  Baylor Scott & White Health
  Dallas, Texas, United States

  Disclosure information not submitted.
• MP

  Manashree Prajapati, MB(ASCP)

  Clinical Molecular Technologist
  Baylor scott and white
  Richardson, Texas, United States

  Disclosure information not submitted.

Purpose/Background: Several genetic markers have been identified that predict the pharmacogenomic effects of opiates and other analgesics. These include CYP2D6, CYP2C9, COMT and MC1R. ERAS protocols implement multimodal pain management strategies aimed at minimizing the need for opioids. By utilizing this standardized patient population, variations in opioid use are more likely attributable to patient-related factors, making this the ideal cohort for establishing pharmacogenetic associations between genetic profiles and analgesia use. The purpose of this pilot study is to examine the relationship between specific genetic markers related to opioid and nonopioid analgesic action and metabolism on post-op analgesic management in 100 patients undergoing elective colorectal resection.Methods/Interventions: All surgical patients undergoing elective colorectal resection utilizing the ERAS protocol at our institution were prospectively recruited. Biomarker assay was then collected via blood analysis. Biomarker assay results were then assigned metabolizer phenotypes for markers: CYP2D6, CYP2C9, COMT and MC1R. Phenotypes were correlated to prospectively gathered average oral morphine equivalent (OME) usage and patient reported pain scores.Results/Outcomes: The first 100 patients of the prospectively collected database were analyzed. OME usage in CYP2D6 normal metabolizers (NM) was 63.5, compared to intermediate metabolizers (IM) group 41.1 (p=.22) and poor metabolizers (PM) group 60.3 (p=.86) Pain scores in CYP2D6 group for NM were 3.8 compared to IM group 3.4 (p=.20) and PM group 3.2 (p=.53) OME usage in CYP2C9 NM was 58.4, compared to IM group 48.2 (p=.54) and PM group 41.6 (p=.39). Pain scores in CYP2C9 group for NM were 3.7 compared to IM group 3.5 (p=.56) and PM group 4.4 (p=.39) OME usage in the COMT normal activity group was 47.2, compared to intermediate activity group 63.7 (p=.49) and low activity group 47.4 (p=.99) Pain scores in COMT normal activity group were 3.5, compared to intermediate group 3.7 (p=.52) and low group 3.9 (p=.35)Conclusion/

Discussion: This pilot study demonstrates the feasibility of utilizing standardized post-operative analgesic regimens to study the effects of pharmacogenomics on OME usage and subjective pain scores in post-op colorectal surgery patients. No statistical difference was detected in pain scores of OME usage due to the small sample size. Data collection is ongoing for a total sample size of 411 patients, which we hope will better inform the growing body of analgesia pharmacogenomics.PhenotypesSummary of the phenotype assay results.