Implementing Genomics in Practice (IGNITE): CYP2D6 Genotype-Guided Pain Management in Patients Undergoing Arthroplasty Surgery
Pain, Postoperative
About this trial
This is an interventional treatment trial for Pain, Postoperative focused on measuring Arthroplasty Surgery, Genotype-Guided Pain Management
Eligibility Criteria
Inclusion Criteria:
- Scheduled to undergo total joint arthroplasty at area hospital
- Primary unilateral total hip or knee arthroplasty scheduled within approximately 6 months of the initial evaluation clinic visit
Exclusion Criteria:
- Patients scheduled to undergo a revision or bilateral procedure
- Receiving chronic opioid therapy, defined as use of opioids on most days for > 3 month
- Allergy to opioids will be excluded.
Sites / Locations
- UF Health at the University of Florida
- Unversity of Florida
- UF Health Orthopaedic--Villages
Arms of the Study
Arm 1
Arm 2
Active Comparator
No Intervention
CYP2D6-guided opioid therapy
Usual Care
Participants randomized to the CYP2D6-guided arm will have their CYP2D6 genotyping completed prior to surgery (in the absence of any genotyping error) with results reported in the electronic health record (EHR). Patients will be categorized as CYP2D6 PM, IM, NM, or UM based on CYP2D6 genotype/activity score and FDA guidance on drug interactions. Strong inhibitors (e.g. bupropion, fluoxetine, paroxetine) phenoconvert patients to PMs, with moderate inhibitors (e.g. duloxetine, fluvoxamine) reducing CYP2D6 activity scores by 50%.
Participants randomized to the usual care arm will have their DNA collected at the start of the study and stored at the lab until after they have completed their surgery and the 2-week follow-up, at which time, their sample was genotyped with the results reported in the EHR.