Pharmacogenetics in obstetric anesthesia.
OBJECTIVE
Genomic research in pain, anesthesia and analgesia generated some hope that pharmacogenetics may guide anesthesiologists to provide effective medicine in a 'tailored' manner. Within the field of obstetric anesthesia, relatively few studies have evaluated the effect of polymorphisms on the perception of labor or postcesarean pain or the response to analgesics for childbirth. Because of the multifactorial nature of labor and delivery pain and particularly challenging clinical context, many consider that 'titration of drugs to the desired effect works just fine'. With recent evidence highlighting an association between severe postdelivery pain and persistent pain, early recognition of an increased susceptibility for acute pain has become particularly relevant.


RESULTS
Neuraxial labor analgesia is influenced by a common polymorphism of the mu-opioid receptor gene. This polymorphism also affects the analgesic response to systemic opioids for postcesarean pain and other types of surgeries. Finally, the risk for persistent pain after cesarean deliveries may be associated with a certain genetic profile.


CONCLUSIONS
Although still premature to anticipate clinical implications and a change in practice based on these recent discoveries, genetic variability clearly appears to affect pain perception, response to analgesics and predisposition for the development of chronic pain.
Landau
Ruth
R
Department of Anesthesiology and Pain Medicine, University of Washington Medical Center, Seattle, Washington 98195-6540, USA. rulandau@u.washington.edu
Kraft
John C
JC
D000701:Analgesics, Opioid / Q000627:therapeutic use; D000773:Anesthesia, Obstetrical / Q000379:methods*; D000775:Anesthesia, Spinal; D002585:Cesarean Section; D003061:Codeine / Q000627:therapeutic use; D005260:Female; D005283:Fentanyl / Q000627:therapeutic use; D020022:Genetic Predisposition to Disease / Q000235:genetics; D006801:Humans; D009020:Morphine / Q000627:therapeutic use; D010146:Pain / Q000188:drug therapy / Q000235:genetics*; D010149:Postoperative Pain / Q000188:drug therapy / Q000235:genetics; D010597:Pharmacogenetics / Q000379:methods*; D011247:Pregnancy; D011957:Receptors, Opioid / Q000235:genetics
D000701:Analgesics, Opioid; D011957:Receptors, Opioid; D009020:Morphine; D005283:Fentanyl; D003061:Codeine