Chronic postsurgical pain in the Evaluation of Nitrous Oxide in the Gas Mixture for Anaesthesia (ENIGMA)-II trial
M T V Chan, P J Peyton, P S Myles, K Leslie, N Buckley, J Kasza, M J Paech, W S Beattie, D I Sessler, A Forbes, S Wallace, Y Chen, Y Tian, W K K Wu, and the Australian and New Zealand College of Anaesthetists Clinical Trials Network for the ENIGMA-II investigators, M T V Chan, P J Peyton, P S Myles, K Leslie, N Buckley, J Kasza, M J Paech, W S Beattie, D I Sessler, A Forbes, S Wallace, Y Chen, Y Tian, W K K Wu, and the Australian and New Zealand College of Anaesthetists Clinical Trials Network for the ENIGMA-II investigators
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.
Keywords: chronic pain; nitrous oxide; polymorphism; single nucleotide; surgery.
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Source: PubMed