Effects of OPRM1 A118G Polymorphism on Epidural Analgesia with Fentanyl During Labor: A Meta-Analysis

摘要

Background: Emerging evidence has shown that the most common polymorphism (A118G; rs1799971 A＞G) in the μ-opioid receptor (OPRM1) gene may influence the response to labor analgesia, but individually published studies showed inconclusive results. Objective: This meta-analysis aimed to derive a more precise estimation of the effects of the 0PRM1 A118G polymorphism on epidural analgesia with fentanyl during labor. Methods: A literature search was conducted on PubMed, Embase, Web of Science, and China BioMedicine databases before April 1st, 2013. The crude standardized mean difference (SMD) or odds ratio (OR) with 95% confidence interval (CI) was calculated. Results: Six clinical studies were included with a total 838 women who received epidural analgesia with fentanyl during labor. The meta-analysis results indicated that women carrying the G allele (AG + GG) of the OPRM1 A118G polymorphism required less fentanyl doses to achieve adequate pain relief compared with those with the AA homozygote (SMD =-0.24, 95% CI [-0.44, -0.03], p = 0.022). The 118G variant was associated with a decreased ED50 of fentanyl for labor analgesia (SMD = -1.56, 95% CI [-1.97, -1.15], p＜ 0.001). The analgesia satisfaction in women carrying the G allele (AG + GG) was higher than those with the AA homozygote (SMD = 0.22, 95% CI [0.05, 0.39], p = 0.012). However, there were no statistically significant differences between an AA homozygote and a G carrier (AG + GG) in the incidence of nausea and vomiting (OR = 1.99, 95% CI [0.88, 4.52], p = 0.101). Conclusion: In conclusion, the current meta-analysis indicates that women carrying the G allele (AG + GG) of OPRM1 A118G polymorphism may have a good response to epidural analgesia with fentanyl during labor. The OPRM1 A118G polymorphism may help predict individuals' response to epidural labor analgesia and so optimize postoperative pain control.