A cohort, double blind, and randomized study was conducted to investigate the effect of a single nucleotide polymorphism of the μ-opioid receptor at nucleotide position 118 (OPRM1:c.118A>G) on the association with the most common side effects (nausea or vomiting) induced by intravenous patient control analgesia (IVPCA) with morphine, including incidence and severity analysis. A total of 129 Taiwanese women undergoing gynecology surgery received IVPCA with pure morphine for postoperative pain relief. Blood samples were collected and sequenced with high resolution melting analysis to detect three different genotypes of OPRM1 (AA, AG, and GG). All candidates 24？h postoperatively will be interviewed to record the clinical phenotype with subjective complaints and objective observations. The genotyping after laboratory analysis showed that 56 women (43.4%) were AA, 57 (44.2%) were AG, and 16 (12.4%) were GG. The distribution of genotype did not violate Hardy-Weinberg equilibrium test. There was no significant difference neither between the severity and incidence of IVPCA morphine-induced side effects and genotype nor between the association between morphine consumption versus genotype. However, there was significant difference of the relation between morphine consumption and the severity and incidence of IVPCA morphine-induced nausea and vomiting. The genetic analysis for the severity and incidence of IVPCA morphine-induced nausea or vomiting showed no association between phenotype and genotype. It might imply that OPRM1:c.118A>G does not protect against IVPCA morphine-induced nausea or vomiting. 1. Introduction IVPCA with pure morphine at present clinical practice was still widely used for postoperative pain management by providing excellent analgesic effect [1, 2]; however, the high incidence of some annoying side effects, especially nausea or vomiting induced by IVPCA morphine, may limit its clinical implication. The most common side effects of IVPCA morphine are nausea or vomiting, with some other less common like pruritus (2% to 10%) [3], urinary retention and respiration depression [4, 5]. The incidence of postoperative nausea or vomiting has been reported from 20% to 30% and the incidence of severe nausea and vomiting around 0.1% [6–8]. The prophylactic protocol or treatment regimen for opioid-induced nausea or vomiting had been elucidated and studied recently with many publications [9–19]. Previous studies investigating the association between IVPCA morphine and the genetic variability of human μ-opioid receptor gene had focused on the difference of
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