CYP3A4 gene expression discloses individual differences in postoperative pain susceptibility and drug treatment response in patients with lung cancer.

Abstract

This study investigates the influence of CYP3A4 gene polymorphisms on postoperative pain sensitivity and analgesic response in lung cancer patients undergoing intercostal nerve block with local anesthetics. Sixty patients (ages 31-74) undergoing thoracoscopic lung cancer surgery were enrolled and divided into two groups based on CYP3A4 gene expression level: Group I (high CYP3A4) and Group II (low CYP3A4). Postoperative pain was assessed using the Visual Analogue Scale (VAS), and patient-controlled intravenous analgesia (PCIA) pump usage, ECG ST-T segment changes, complications, hospital stay, and costs were recorded. Results showed significantly higher VAS scores, PCIA usage, ST-T depression, complications, longer hospital stay, and higher costs in Group I compared to Group II (P < 0.05). These findings suggest that higher CYP3A4 expression is associated with increased postoperative pain, complications, and healthcare cost. According to CYP3A4 gene expression activity, which was determined before surgery, patients with low enzyme activity metabolized local anesthetics slowly, which resulted in better analgesic effect and a longer duration of intercostal nerve block anesthesia. Owing to the impact of CYP3A4 gene expression on local anesthetic metabolism, precise intercostal nerve block anesthesia and individualized pain treatment plans could be formulated for patients undergoing radical thoracoscopic surgery for lung cancer. This may accelerate postoperative recovery from lung cancer and reduce both the length of hospital stay and hospitalization costs.