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Chen YH, Xenitidis A, Hoffmann P, Matthews L, Padmanabhan SG, Aravindan L, Ressler R, Sivam I, Sivam S, Gillispie CF, Sadhasivam S. Opioid use disorder in pediatric populations: considerations for perioperative pain management and precision opioid analgesia. Expert Rev Clin Pharmacol 2024:1-11. [PMID: 38626303 DOI: 10.1080/17512433.2024.2343915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 04/12/2024] [Indexed: 04/18/2024]
Abstract
INTRODUCTION Opioids are commonly used for perioperative analgesia, yet children still suffer high rates of severe post-surgical pain and opioid-related adverse effects. Persistent and severe acute surgical pain greatly increases the child's chances of chronic surgical pain, long-term opioid use, and opioid use disorder. AREAS COVERED Enhanced recovery after surgery (ERAS) protocols are often inadequate in treating a child's severe surgical pain. Research suggests that 'older' and longer-acting opioids such as methadone are providing better methods to treat acute post-surgical pain. Studies indicate that lower repetitive methadone doses can decrease the incidence of chronic persistent surgical pain (CPSP). Ongoing research explores genetic components influencing severe surgical pain, inadequate opioid analgesia, and opioid use disorder. This new genetic research coupled with better utilization of opioids in the perioperative setting provides hope in personalizing surgical pain management, reducing pain, opioid use, adverse effects, and helping the fight against the opioid pandemic. EXPERT OPINION The opioid and analgesic pharmacogenomics approach can proactively 'tailor' a perioperative analgesic plan to each patient based on underlying polygenic risks. This transition from population-based knowledge of pain medicine to individual patient knowledge can transform acute pain medicine and greatly reduce the opioid epidemic's socioeconomic, personal, and psychological strains globally.
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Affiliation(s)
- Yun Han Chen
- Department of Anesthesiology and Pain Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Paul Hoffmann
- Department of Anesthesiology and Pain Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA
| | - Leslie Matthews
- Department of Anesthesiology and Pain Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA
| | | | | | - Ruth Ressler
- Department of Biochemistry and Molecular Biology, The College of Wooster, Wooster, OH, USA
| | - Inesh Sivam
- North Allegheny High School, Pittsburgh, PA, USA
| | - Sahana Sivam
- North Allegheny High School, Pittsburgh, PA, USA
| | - Chase F Gillispie
- Marshall University Joan C. Edwards School of Medicine, Huntington, WV, USA
| | - Senthilkumar Sadhasivam
- Department of Anesthesiology and Pain Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA
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Aruldhas BW, Quinney SK, Packiasabapathy S, Overholser BR, Raymond O, Sivam S, Sivam I, Velu S, Montelibano A, Sadhasivam S. Effects of oxycodone pharmacogenetics on postoperative analgesia and related clinical outcomes in children: a pilot prospective study. Pharmacogenomics 2023; 24:187-197. [PMID: 36946298 PMCID: PMC10061242 DOI: 10.2217/pgs-2022-0149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 12/19/2022] [Indexed: 03/23/2023] Open
Abstract
Background: Variability in the pharmacokinetics and pharmacodynamics of oxycodone in children undergoing surgery could be due to genetic polymorphisms. Materials & methods: The authors studied the association between clinical outcomes and pharmacogenes in children undergoing major surgery. A total of 89 children (35 undergoing pectus excavatum repair and 54 undergoing spinal fusion) were recruited. Results: OPRM1 SNP rs6902403 showed an association with maximum pain score and total morphine equivalent dose (p < 0.05). Other polymorphisms in OPRM1 SNP, PXR, COMT and ABCB1 were also shown to be associated with average morphine equivalent dose, length of hospital stay and maximum surgical pain (p < 0.05). Conclusion: This study demonstrates novel associations between the above pharmacogenes and oxycodone's pharmacokinetics as well as postoperative outcomes in children. Clinical trial registration: NCT03495388 (ClinicalTrials.gov).
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Affiliation(s)
- Blessed W Aruldhas
- Division of Clinical Pharmacology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
- Department of Anesthesia, Indiana University School of Medicine, Indianapolis, IN, USA
- Department of Pharmacology & Clinical Pharmacology, Christian Medical College, Vellore, India
| | - Sara K Quinney
- Division of Clinical Pharmacology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
- Department of Obstetrics & Gynecology, Indiana University School of Medicine, Indianapolis, IN, USA
- Center for Computational Biology & Bioinformatics, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - Brian R Overholser
- Division of Clinical Pharmacology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
- Center for Computational Biology & Bioinformatics, Indiana University School of Medicine, Indianapolis, IN, USA
- Department of Pharmacy Practice, Purdue University College of Pharmacy, Indianapolis, IN, USA
| | - Olivia Raymond
- Department of Anesthesiology & Perioperative Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Sahana Sivam
- North Allegheny Intermediate High School, Pittsburgh, PA 15237, USA
| | - Inesh Sivam
- North Allegheny Intermediate High School, Pittsburgh, PA 15237, USA
| | | | - Antoinette Montelibano
- Department of Anesthesiology & Perioperative Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Senthilkumar Sadhasivam
- Department of Anesthesia, Indiana University School of Medicine, Indianapolis, IN, USA
- Department of Anesthesiology & Perioperative Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
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Lin A, Marshall N, Visser S, Jo H, Al-Hindawi Y, Aquino-Salomon T, Lau E, Yozghatlian V, Sivam S. 48: Adult diagnosis of cystic fibrosis in Australia. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01473-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Bell J, Sivam S, Dentice R, Dwyer T, Jo H, Lau E, Lee W, Munoz P, Shah K, Taylor N, Visser S, Yozghatlian V, Wong K. P100 Quality of home spirometry performance amongst adults with cystic fibrosis. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01126-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Barry L, Drennan P, Sivam S, Van Hal S. P152 Practical challenges to daily intravenous tobramycin dosing in patients with cystic fibrosis. J Cyst Fibros 2020. [DOI: 10.1016/s1569-1993(20)30487-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Sivam S, Al-Hindawi Y, Di Michiel J, Moriarty C, Spratt P, Jansz P, Malouf M, Plit M, Pleass H, Havryk A, Bowen D, Haber P, Glanville AR, Bye PTP. Liver and lung transplantation in cystic fibrosis: an adult cystic fibrosis centre's experience. Intern Med J 2017; 46:852-4. [PMID: 27405894 DOI: 10.1111/imj.13126] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 12/09/2015] [Accepted: 12/13/2015] [Indexed: 01/12/2023]
Abstract
Liver disease develops in one-third of patients with cystic fibrosis (CF). It is rare for liver disease to have its onset after 20 years of age. Lung disease, however, is usually more severe in adulthood. A retrospective analysis was performed on nine patients. Three patients required lung transplantation approximately a decade after liver transplant, and another underwent combined liver and lung transplants. Four additional patients with liver transplants are awaiting assessment for lung transplants. One patient is awaiting combined liver and lung transplants. With increased survival in CF, several patients may require more than single organ transplantation.
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Affiliation(s)
- S Sivam
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Y Al-Hindawi
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - J Di Michiel
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - C Moriarty
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - P Spratt
- Lung Transplantation Unit, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - P Jansz
- Lung Transplantation Unit, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - M Malouf
- Lung Transplantation Unit, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - M Plit
- Lung Transplantation Unit, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - H Pleass
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Liver Transplant Unit, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - A Havryk
- Lung Transplantation Unit, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - D Bowen
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - P Haber
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Addiction Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - A R Glanville
- Lung Transplantation Unit, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - P T P Bye
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
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Sivam S, Yozghatlian V, Dentice R, McGrady M, Moriarty C, Di Michiel J, Bye PTP, Rees D. Spontaneous coronary artery dissection associated with coughing. J Cyst Fibros 2013; 13:235-7. [PMID: 24157355 DOI: 10.1016/j.jcf.2013.10.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Revised: 09/30/2013] [Accepted: 10/01/2013] [Indexed: 10/26/2022]
Affiliation(s)
- S Sivam
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW 2050, Australia; Department of Respiratory Medicine, University of Sydney, NSW 2006, Australia.
| | - V Yozghatlian
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW 2050, Australia; Department of Respiratory and Sleep Medicine, St. George Hospital, 30 Gray Street, Kogarah, NSW 2217, Australia
| | - R Dentice
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW 2050, Australia; Department of Respiratory Medicine, University of Sydney, NSW 2006, Australia
| | - M McGrady
- Department of Respiratory Medicine, University of Sydney, NSW 2006, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW 2050, Australia
| | - C Moriarty
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW 2050, Australia; Department of Respiratory Medicine, University of Sydney, NSW 2006, Australia
| | - J Di Michiel
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW 2050, Australia; Department of Respiratory Medicine, University of Sydney, NSW 2006, Australia
| | - P T P Bye
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW 2050, Australia; Department of Respiratory Medicine, University of Sydney, NSW 2006, Australia
| | - D Rees
- Department of Cardiology, St. George Hospital, 30 Gray Street, Kogarah, NSW 2217, Australia
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Sivam S, Moreno C. P2.091 D1 antagonist blocks L-DOPA-induced striatal and nigral ERK1/2 phosphorylation in a rat model of Parkinson's disease. Parkinsonism Relat Disord 2009. [DOI: 10.1016/s1353-8020(09)70442-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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