Nötrofil/Lenfosit Oranının Postoperatif Ağrı İçin Öngörücü Rolü

Öz

Amaç: Ameliyat sonrası ağrı, cerrahi işlemin neden olduğu akut inflamasyon ile yakından ilişkilidir. Çalışmamızda, sistemik bir inflamasyon belirteci olarak nötrofil/lenfosit oranı (NLR) ile postoperatif ağrının belirteci olarak postoperatif analjezik tüketimi arasındaki ilişkiyi araştırmak amaçlandı. Gereç ve Yöntem: Çalışmada 18-55 yaşları arasında genel anestezi altında septorinoplasti uygulanan olguların verileri analiz edildi ve American Society of Anesthesiologists (ASA) sınıflamasına göre sınıf I-II olarak değerlendirildi. Hastaların demografik verileri, ASA skorları, operasyon süresi ve postoperatif dönemdeki toplam analjezik tüketimi kaydedildi. Hastalar preoperatif NLO'ya göre iki gruba ayrıldı. Buna göre NLO <2 olan hastalar Grup 1, NLO ≥2 olan hastalar Grup 2 idi. Bulgular: Çalışmaya toplam 116 vaka dahil edildi. Demografik veriler ve operasyon süreleri açısından iki grup arasında istatistiksel olarak anlamlı fark yoktu (p>0.05). Grup 1 ve 2'de ortalama NLR sırasıyla 1,46±0,29 ve 2,64±0,74 idi. Grup 2'nin, Grup 1'e göre istatistiksel olarak anlamlı derecede yüksek postoperatif analjezik tüketimine sahip olduğu belirlendi (p=0,006). Sonuç: Çalışmamızda elde edilen veriler ışığında ameliyat öncesi NLR'nın ameliyat sonrası ağrıyı öngörerek uygun tedavi stratejilerinin belirlenmesinde yol gösterici bir belirteç olarak değerlendirilebileceği sonucuna varıldı.

Anahtar Kelimeler

• Nötrofil/lenfosit oranı
• postoperatif ağrı
• analjezik tüketimi
• septorinoplasti

Predictive Role of Neutrophil/Lymphocyte Ratio for Postoperative Pain

Öz

Aim:Postoperative pain is closely associated with acute inflammation caused by the surgical procedure. In our study, the aim was to investigate the correlation between neutrophil/lymphocyte ratio (NLR) as a systemic inflammation markerwith postoperative analgesic consumption as a marker of postoperative pain. Material and Method: The study analysed data from cases undergoing septorhinoplasty under general anaesthesia aged from 18-55 years and assessed as class I-II according to American Society of Anesthesiologists (ASA) classification. The demographic data of patients, ASA scores, operation duration and total analgesic consumptionin the postoperative period were recorded. Patients were divided into two groups according to preoperative NLR. Accordingly, patients with NLR <2 were Group 1, while patients with NLR ≥2 were Group 2. Results: The study included a total of 116 cases. There were no statistically significant differences between the two groups in terms of demographic data and operation durations (p>0.05). The mean NLR in Groups 1 and 2 were 1.46±0.29 and 2.64±0.74, respectively. Group 2 were identified to have statistically significantly higher postoperative analgesic consumption compared to Group 1 (p=0.006). Conclusion: In light of data obtained in our study, it was concluded that preoperative NLR may be assessed as a guiding marker for determination of appropriate treatment strategies by predicting postoperative pain.

Anahtar Kelimeler

• Neutrophil/lymphocyte ratio
• postoperative pain
• analgesic consumption
• septorhinoplasty

Kaynakça

1. 1. Gottschalk A, Smith DS. New concepts in acute pain therapy: preemptive analgesia. Am Fam Physician 2001;63:1979–84.
2. 2. Ramsay MA. Acute postoperative pain management. Proc (BaylUniv Med Cent) 2000;13:244‑7.
3. 3. Gupta A, Kaur K, Sharma S, Goyal S, Arora S, Murthy RS. Clinical aspects of acute post-operative pain management and its assessment. J Adv Pharm Technol Res 2010; 1:97-108.
4. 4. Zhang JM, An J. Cytokines inflammation and pain. Int Anesthesiol Clin 2007;45:27-37.
5. 5. Iwase M, Kondo G, Watanabe H, et al. Regulation of Fas-mediated apoptosis in neutrophils after surgery induced acute inflammation. J Surg Res 2006; 134: 114-23.
6. 6. Ogawa K, Hirai M, Katsube T, et al. Suppression of cellular immunity by surgical stress. Surgery 2000; 127: 329-36.
7. 7. Ni Eochagain, A, Burns D, Buggy DJ. Effect of anaesthetic technique during primary breast cancer surgery on neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, and time of commencement of intended oncologic therapy: a follow-up analysis of a prospective randomised trial. Br J Anaeth 2018; 120: e2-3.
8. 8. Gibson PH, Croal BL, Cuthbertson BH, et al. Preoperative neutrophil‑lymphocyte ratio and outcome from coronary artery bypass grafting. Am Heart J 2007;154:995‑1002.

9. 9. Wei B, Yao M, Xing C, et al. The neutrophil lymphocyte ratio is associated with breast cancer prognosis: an updated systematic review and meta-analysis. Onco Targets Ther 2016;9:5567-75.
10. 10. Kölükçü E, Kılıç Ş, Atılgan D, et al. Clinical relevance of preoperative neutrophil to lymphocyte and platelet to lymphocyte ratio in renal cell carcinoma. J UrolSurg 2018;5:189-93.
11. 11. Turgut HC, Alkan M, Ataç MS, et al. Neutrophil lymphocyte ratio predicts postoperative pain after orthognathic surgery. Niger J Clin Pract 2017;20:1242-5.
12. 12. Şıvgın V, Dikmen B, Orhan Ö, Kanatlı U, Arslan M, Kurtipek Ö. Effects of neutrophil/lymphocyte ratio on postoperative pain in shoulder arthroscopy patients. TurkiyeKlinikleri J AnestReanim 2017;15:95-9.
13. 13. Erbaş M, Toman H, Gencer M, et al. The effect of general and spinal anesthesia on neutrophil to lymphocyte ratio in patients undergoing cesarian section. Anaesth Pain Intensive Care 2015;19: 485-8.
14. 14. Kim WH, Jin HS, Ko JS, et al. The effect of anesthetic techniques on neutrophil-to-lymphocyte ratio after laparoscopy-assisted vaginal hysterectomy. Acta Anaesthesiol Taiwan 2011;49:83-7.
15. 15. Venkatraghavan L, Tan TP, Mehta J, Arekapudi A, Govindarajulu A, Siu E. Neutrophil lymphocyte ratio as a predictor of systemic inflammation - a cross-sectional study in a pre-admission setting. F1000Res 2015;4:123.
16. 16. Daoudia M, Decruynaere C, Le Polain de Waroux B, Thonnard JL, Plaghki L, Forget P. Biological inflammatory markers mediate the effect of preoperative pain‑related behaviours on postoperative analgesics requirements. BMC Anesthesiol 2015;15:18.
17. 17. Bugada D, Lavand’homme P, Ambrosoli AL, et al. Effect of preoperative inflammatory status and comorbidities on pain resolution and persistent postsurgical pain after inguinal hernia repair. MediatInflamm 2016;2016:5830347.
18. 18. Hong J, Mao Y, Chen X, et al. Elevated preoperative neutrophil-to-lymphocyte ratio predicts poor disease-free survival in Chinese women with breast cancer. Tumour Biol 2016;37:4135-42.
19. 19. Qin B, Ma N, Tang Q, et al. Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) were useful markers in assessment of inflammatory response and disease activity in SLE patients. Mod Rheumatol 2016;26:372-6.
20. 20. Canbolat N, Buget MI, Sivrikoz N, Altun D, and Kucukay S. The relationship between neutrophil to lymphocyte ratio and postoperative pain in total knee and hip arthroplasty. Rev Bras Anestesiol 2019;69:42-7.
21. 21. Alkan M, Erkent FD, Celik A, Gokce A, Arslan M, Unal Y. Effects of thoracic epidural or intravenous analgesia on the neutrophil-to-lymphocyte ratio in thoracotomy cases. Niger J Clin Pract 2018; 21: 1337-40.
22. 22. Sommer M, Geurts JW, Stessel B, et al. Prevalence and predictors of postoperative pain after ear, nose, and throat surgery. Arch Otolaryngol Head Neck Surg 2009;135:124–30.