The Effect of Postoperative Analgesia Induced by Peripheral Nerve Block on Inflammatory Biomarkers in Patients Undergoing Upper Extremity Surgery

Öz

Introduction: Surgical stress, along with anesthetic and analgesic agents, antiemetics, and blood products, may initiate a cascade of inflammatory processes. Perioperative inflammation contributes not only to acute pain but also to a spectrum of postoperative adverse outcomes, including chronic pain, delirium, cardiovascular events, and cancer recurrence (1,2). Consequently, strategies aimed at limiting the inflammatory response may exert beneficial effects on postoperative recovery. Experimental studies have demonstrated that local anesthetics attenuate the inflammatory response—reflected by the Neutrophil-to-Lymphocyte Ratio (NLR) and Platelet-to-Lymphocyte Ratio (PLR)—through modulation of various components of the inflammatory cascade (3). The aim of this study was to retrospectively evaluate the impact of brachial plexus blocks used for postoperative analgesia in upper extremity surgery on postoperative inflammatory response, as assessed by hematological biomarkers. Materials and Methods: Following approval from the institutional ethics committee (Sancaktepe BAEK2025/373), patients who underwent unilateral upper extremity surgery under general anesthesia and received a brachial plexus block for analgesic purposes were retrospectively reviewed. Group G comprised 22 patients who received general anesthesia alone, whereas Group P included 45 patients who received a peripheral nerve block in addition to general anesthesia. Results: Demographic variables and ASA classifications were comparable between the two groups. Preoperative and postoperative total leukocyte count (TLC), neutrophil, lymphocyte, platelet count, and mean platelet volume (MPV) did not differ significantly between the groups (all p>0.05). No significant differences were observed in preoperative or postoperative NLR and PLR values. Changes in hematological parameters from the preoperative to postoperative period (ΔTLC, ΔNLR, ΔPLR) were also similar across the groups (p=0.517, p=0.674, p=0.704). Discussion: In our study, although statistical significance was not achieved, postoperative increases in inflammatory markers such as NLR, PLR, and MPV were observed to be lower in patients who received a peripheral nerve block for postoperative analgesia compared with those who did not receive a block and underwent forearm surgery under general anesthesia. In the study by Köksal et al., infraclavicular block performed for anesthesia in forearm surgery resulted in a significant reduction in bioinflammatory markers compared with general anesthesia (4). Additionally, two studies comparing general and spinal anesthesia reported that spinal anesthesia was associated with a smaller increase in NLR (5). The literature further demonstrates that the ESP block administered in lumbar stabilization surgery leads to lower VAS scores and attenuated increases in inflammatory biomarkers (3). As a result, we believe that peripheral nerve blocks applied as part of multimodal analgesia may exert favorable effects on postoperative bioinflammatory markers.

Anahtar Kelimeler

• neutrophil lymphocyte ratio
• platelet lymphocyte ratio
• regional anesthesia

Destekleyen Kurum

This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

Etik Beyan

Approval for the study was granted by the Prof. Dr. Şehit İlhan Varank EAH Non- Interventional Clinical Research Ethics Committee (Sancaktepe BAEK 2025/373).

ÜST EKSTREMİTE CERRAHİSİ GEÇİREN HASTALARDA PERİFERİK BLOK İLE SAĞLANAN POSTOPERATİF ANALJEZİNİN İNFLAMATUAR BİYOBELİRTEÇLERE ETKİSİ

Öz

Giriş: Cerrahi stres, anestezik ve analjezik ajanlar, antiemetikler, kan ürünleri gibi faktörler inflamatuar süreçleri tetikleyebilir. Perioperatif inflamasyon, akut ağrının yanında kronik ağrı, deliryum, kardiyovasküler olaylar ve kanser rekürrensi gibi çeşitli postoperatif olumsuz sonuçlara neden olmaktadır (1,2). Bu nedenle, inflamatuar yanıtı sınırlayan stratejiler iyileşme üzerinde olumlu etkiler sağlayabilir. Deneysel çalışmalar, lokal anesteziklerin inflamatuar kaskadın çeşitli basamaklarını modüle ederek Nötrofil/Lenfosit Oranı (NLR) ve Platelet/Lenfosit Oranı (PLR) ile ifade edilen inflamasyon yanıtını azalttığını göstermektedir (3). Amacımız üst ekstremite cerrahilerinde postoperatif analjezide kullanılan brakial pleksus bloklarının postoperatif inflamatuar yanıta etkilerini biyobelirteçlerle retrospektif değerlendirmektir. Gereç Yöntem: Etik kurul onayı sonrası (Sancaktepe BAEK2025/373), unilateral üst ekstremite cerrahisi yapılmış, genel anestezi uygulanan ve analjezi amaçlı brakial pleksus bloğu gerçekleştirilen hastalar retrospektif tarandı. Grup G’de genel anestezi uygulanmış 22 hasta, Grup P’de ise genel anesteziye ek periferik sinir bloğu uygulanmış 45 hasta incelendi. Sonuç: Demografik veriler ve ASA skorlarının dağılımı iki grupta benzerdi. Preoperatif ve postoperatif total lökosit (TLC), nötrofil, lenfosit, trombosit sayısı ve ortalama trombosit hacmi (MPV) iki grupta benzerdi (tüm p>0.05). Preoperatif ve postoperatif NLR ve PLR değerlerinde anlamlı fark saptanmadı. Hematolojik parametrelerde preoperatiften postoperatife olan değişiklikler (ΔTLC, ΔNLR, ΔPLR) iki grupta benzerdi (p=0.517,p=0.674,p=0.704). Tartışma: Çalışmamızda genel anestezi ile ön kol cerrahisi uygulanmış olan hastalarda postoperatif ağrı tedavisi için periferik sinir bloğu uygulanan hastalarda blok uygulanmayan hastalara göre postoperatif NLR, PLR ve MPV gibi inflamatuar belirteçlerde istatistiksel olarak anlamlı olmasa da artışın daha az olduğunu gözlemledik. Köksal ve arkadaşlarının yaptığı çalışmada ön kol cerrahisi geçiren hastalarda anestezi amaçlı yapılan infraklavikular bloğun genel anesteziye kıyasla biyoinflamatuar belirteçlerde anlamlı düşüş sağladığı gözlenmiştir(4). Genel ve spinal anestezinin karşılaştırıldığı iki çalışmada spinal anestezinin NLR’yi daha az artırdığı bulunmuştur(5). Lomber stabilizasyon cerrahisi geçiren hastalara uygulanan ESP bloğun daha düşük VAS skorlarına ve inflamatuar biyobelirteçlerde daha az artışa neden olduğu literatürde gösterilmiştir(3). Sonuç olarak multimodal analjezinin bir parçası olarak uygulanan periferik sinir bloğunun postoperatif biyoinflamatuar belirteçler üzerinde olumlu etkileri olacağı görüşündeyiz.

Anahtar Kelimeler

• nötrofil lenfosit oranı
• platelet lenfosit oranı
• rejyonel anestezi

Destekleyen Kurum

Bu araştırma, kamu, ticari veya kâr amacı gütmeyen herhangi bir finansman kuruluşundan özel bir destek almamıştır.

Etik Beyan

Çalışma için onay, Prof. Dr. Şehit İlhan Varank Eğitim ve Araştırma Hastanesi Girişimsel Olmayan Klinik Araştırmalar Etik Kurulu tarafından verilmiştir (Sancaktepe BAEK 2025/373)

Kaynakça

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