Journal of clinical pharmacy and therapeutics
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Clinical investigations into postoperative intravenous patient-controlled analgesia (PCA) have indicated interindividual differences in fentanyl consumption. Cytochrome P450 3A4 (CYP3A4) is the main metabolism enzyme of fentanyl, and single nucleotide polymorphisms within the CYP3A4 gene may contribute to the variability of fentanyl analgesic efficacy. The aim of this study was to investigate whether the most common genetic variation in Chinese, CYP3A4*1G, has an impact on the fentanyl consumption for intravenous PCA in Chinese Han women undergone abdominal total hysterectomy. ⋯ CYP3A4*1G has an impact on the analgesic effect of fentanyl in Chinese Han subjects. Further validation of our results in a well-powered study would be helpful.
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The phenomenon of opioid-induced hyperalgesia (OIH), an increased sensitivity to pain attributed to the very opioid drugs administered to manage the pain, is well established in animal models, and there is concern that it also occurs in patients. Our objective is to briefly summarize the basic science and clinical evidence about OIH as background to consider the possible benefit of using a multi-mechanistic analgesic approach. ⋯ We suggest that multi-mechanistic analgesia, accomplished within either a single drug or a combination of drugs, is a logical approach that might result in a reduced development of OIH.