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Research Snapshot Theater: Cardiovascular/Pharmacology, Adult II

Effect of Pharmacogenomic Genes on Patient-Reported Postoperative Pain

Tuesday, March 24, 2026
10:00 AM - 11:00 AM Central Time
Location: Connections Central - RST 02
Introduction: This study assesses impact of pharmacogenomic (PGx) guided selection of analgesics following cardiac surgery and association between specific pharmacogenes and analgesics. This study focuses on pharmacogenes having initial evidence to support implementation in clinical care.


Methods: Population of adult patients undergoing cardiac surgery at Cleveland Clinic receiving IV fentanyl intraoperatively and second opioid.
Objective assesses association between post-op pain management and phenotypes of pharmacogenomics genes: CYP2D6 and OPRM1. Patients categorized into group A and B based on phenotypes. Group A expected better pain management vs Group B. Effectiveness measured by (1) time weighted average and VAS pain score; (2) opioid consumption (morphine equivalents); (3) alternatives, in first and second 24-hours postoperatively. More effective pain management defined as noninferiority in TWA pain scores, opioid use, and use of alternatives.


Results: CYP2D6: First 48 hours postoperatively, cumulative opioid consumption median [IQR] of 122 mg [71, 184] group A (ultra-rapid/normal metabolizer) vs 96 mg [56, 174] group B (intermediate/poor metabolizer) (ratio of geometric means (97.5% CI of noninferiority test): 1.14 (0.83, 1.58), P=0.268). Average pain score 2.86 (SD 1.59) group A vs 2.81 (SD 1.60) group B (difference in means (97.5% CI of noninferiority test): 0.05 (-0.29, 0.40), P< 0.001). 71 patients (42%) group A consumed non-opioid pain medications, vs 49 patients (37%) in group B (OR (97.5% CI of noninferiority test): 1.05 (0.94, 1.16), P=0.002).

OPRM1: First 48 hours group A compared to 121 mg [71, 193] group B (ratio of geometric means (97.5% CI of noninferiority test): 0.89 (0.63, 1.25), P=0.012). Avg pain score 2.77 (SD 1.56) in group A vs 3.00 (SD 1.59) in group B (difference in means (97.5% CI of noninferiority test): -0.26 (-0.64, 0.11), P< 0.001). 94 patients (38%) group A consumed non-opioid medications, vs 35 patients (43%) in group B (OR (97.5% CI of noninferiority test): 0.98 (0.87, 1.10), P< 0.001).


Conclusions: This interim analysis demonstrated a trend towards increasing requirement for both opioid consumption in those who carry an OPRM1 variant or in the CYP2D6 group A phenotype (ultra-rapid/normal metabolizer) versus group B phenotype (intermediate/poor metabolizer).