Pharmacogenetic Approaches in Personalized Medicine for Postoperative Pain Management: a Systematic Review

Abstract

Background: Despite technical and pharmacological advancements in recent years, including optimized therapies and personalized medicine, postoperative pain (POP) management remains challenging and sometimes undertreated. This systematic review aims to summarize and update how genotype-guided therapeutics within personalized medicine can enhance postoperative pain management. Methods: A systematic review was conducted according to PRISMA guidelines and divided into two analyses according to study type. The aim of this research was to evaluate the impact of genotype-guided therapeutics in postoperative pain outcomes as well as to compile information regarding the main genes related to POP. Results: 29 reports (4 controlled and 25 non-controlled studies) were included in the results. Controlled clinical trials demonstrated a significantly lower opioid consumption associated with employing genotype-guided therapeutics with some also showing lower pain levels. OPRM1, CYP2D6, CYP2C, CYP2C19, CYP2C9, CYP2D6, ABCB1, CYP3A4 and COMT polymorphisms were associated with different POP outcomes. Conclusions: This study underscores the integration of pharmacogenetic-guided personalized medicine into perioperative care, particularly when there is uncertainty regarding opioid prescriptions. This approach leads to superior outcomes in terms of postoperative pain relief and reduced morbidity for numerous patients.