Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/16516
Title: Chronic postsurgical pain in the Evaluation of Nitrous Oxide in the Gas Mixture for Anaesthesia (ENIGMA)-II trial
Austin Authors: Chan, MTV;Peyton, Philip J ;Myles, PS;Leslie, K;Buckley, N;Kasza, J;Paech, MJ;Beattie, WS;Sessler, DI;Forbes, A;Wallace, S;Chen, Y;Tian, Y;Wu, WKK
Institutional Author: Australian and New Zealand College of Anaesthetists Clinical Trials Network for the ENIGMA-II investigators
Affiliation: Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
Department of Anaesthesia, Austin Health, Heidelberg, Victoria, Australia
Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
Department of Anaesthesia and Perioperative Medicine, The Alfred Hospital, Melbourne, Victoria, Australia
Department of Anaesthesia and Perioperative Medicine, Monash University, Melbourne, Victoria, Australia
Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Melbourne, Victoria, Australia
Anaesthesia, Perioperative and Pain Medicine Unit, University of Melbourne, Melbourne, Victoria, Australia
Department of Pharmacology and Therapeutics, University of Melbourne, Melbourne, Victoria, Australia
Department of Anesthesia, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
Department of Anaesthesia and Pain Medicine, Royal Perth Hospital, Perth, Western Australia, Australia
School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia
Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada
Department of Anaesthesia, Toronto General Hospital, Toronto, Ontario, Canada
Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA
Li Ka Shing Institute of Health Sciences, Institute of Digestive Disease, Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
State Key Laboratory of Digestive Disease, Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
Issue Date: Dec-2016
metadata.dc.date: 2016-12
Publication information: British Journal of Anaesthesia 2016; 117(6): 801-811
Abstract: BACKGROUND: Previous animal and clinical studies showed that nitrous oxide may produce long-term analgesia. The aim of this study was to evaluate the effect of nitrous oxide in preventing chronic postsurgical pain. We also explored whether methylenetetrahydrofolate reductase gene polymorphisms (1298A>C, 667C>T) would enhance nitrous oxide analgesia. METHODS: We conducted a telephone interview at 12 months after surgery on 2924 (41.1%) patients enrolled in the Evaluation of Nitrous Oxide in the Gas Mixture for Anaesthesia-II trial. Pain at the wound site was recorded using the modified brief pain inventory and the neuropathic pain questionnaire. General health status was measured using the EQ-5D questionnaire. Genotyping was performed in a subset of 674 Asian patients in Hong Kong. RESULTS: At 12 months after surgery, 356 (12.2%) patients reported chronic postsurgical pain at the wound site and 112 (3.8%) patients had severe pain and required regular analgesic interventions. Nitrous oxide did not affect the rate of chronic postsurgical pain (11.8% nitrous oxide group; 12.5% no nitrous oxide group), relative risk (95% confidence intervals): 0.94 (0.75-1.17), P=0.57. However, in a planned subgroup analysis, nitrous oxide reduced the risk of chronic postsurgical pain in Asian patients, relative risk (95% confidence intervals): 0.70 (0.50-0.98), P=0.031. Patients who were homozygous for either gene polymorphism and who received nitrous oxide during surgery were less likely to report chronic postsurgical pain. CONCLUSIONS: Nitrous oxide administration had no impact on chronic postsurgical pain, but benefits may still be possible in Asian patients and patients with variants in methylenetetrahydrofolate reductase gene. CLINICAL TRIAL REGISTRATION: NCT00430989.
URI: http://ahro.austin.org.au/austinjspui/handle/1/16516
DOI: 10.1093/bja/aew338
PubMed URL: https://pubmed.ncbi.nlm.nih.gov/27956679
Type: Journal Article
Subjects: Chronic pain
Nitrous oxide
Polymorphism
Single nucleotide
Surgery
Appears in Collections:Journal articles

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