OPRM1 A118G gene variant and postoperative opioid requirement: a systematic review and meta-analysis.

BACKGROUND Although a number of studies have investigated the association of the OPRM1 A118G polymorphism with pain response, a consensus has not yet been reached. METHODS The authors searched PubMed, EMBASE, and the Cochrane Library to identify gene-association studies that explored the impact of the OPRM1 A118G polymorphism on postoperative opioid requirements through July 2013. Two evaluators independently reviewed and selected articles on the basis of prespecified selection criteria. The authors primarily investigated the standardized mean difference (SMD) of required amounts of opioids between AA homozygotes and G-allele carriers. The authors also performed subgroup analyses for race, opioid use, and type of surgery. Potential bias was assessed using the Egger's test with a trim and fill procedure. RESULTS Three hundred forty-six articles were retrieved from databases, and 18 studies involving 4,607 participants were included in the final analyses. In a random-effect meta-analysis, G-allele carriers required a higher mean opioid dose than AA homozygotes (SMD, -0.18; P = 0.003). Although there was no evidence of publication bias, heterogeneity was present among studies (I(2) = 66.8%). In the subgroup meta-analyses, significance remained robust in Asian patients (SMD, -0.21; P = 0.001), morphine users (SMD, -0.29; P <0.001), and patients who received surgery for a viscus (SMD, -0.20; P = 0.008). CONCLUSIONS The OPRM1 A118G polymorphism was associated with interindividual variability in postoperative response to opioids. In a subpopulation, identifying OPRM1 A118G polymorphism may provide valuable information regarding the individual analgesic doses that are required to achieve satisfactory pain control.