Comparison of the effects of general and regional anesthesia on neutrophil-lymphocyte ratio, platelet-lymphocyte ratio and mean platelet volume in urological endoscopic interventions

Introduction and Purpose: Neutrophil Lymphocyte Ratio (NLR), Platelet Lymphocyte Ratio (PLO), and Mean Platelet Volume (MPV) are popular hematological parameters used as an indicator of subclinical inflammation. These rates are affected not only by surgical trauma but also by the anesthetic method. Effects of neuroendocrine changes caused by different anesthetic techniques can affect NLR, PLO, and MPV. In this study, we compared the effects of anesthesia techniques applied in urological endoscopic procedures on NLR, PLO and MPV. Methods: This study was conducted prospectively between January 2022 and September 2022 in Şanlıurfa Harran University Faculty of Medicine Hospital, Department of Anesthesiology and Reanimation, after the approval of Şanlıurfa Harran University Faculty of Medicine Ethics Committee (decision dated 07.01.2022 and numbered 96469). In our study, urolithiasis retrograde intrarenal surgery (RIRC) and ureterorenoscopy (URS) operation will be performed in the Urology Department of our faculty, who read and signed the informed voluntary consent form, ASA I-II-III group according to the American Society of Anesthesiologists (ASA) physical classification, over 18 years of age, elective surgery. 90 volunteer patients planned were included in the study. Before the operation, the patients were informed about general, spinal and epidural anesthesia. Afterwards, the patients were divided into 3 groups of 30 each as General Anesthesia Group (Group G, n=30), Spinal Anesthesia Group (Group S, n=30), and Epidural Anesthesia Group (Group G, n=30). Anesthesia was induced with propofol 2 mg/kg, fentanyl 2 mcg/kg, and rocuronium 0.6 mg/kg if intubated in patients in Group G. Then, the patient was connected to the ventilator by inserting an LMA or endotracheal tube suitable for his age and weight. Patients in Group S underwent spinal block with 2.5-3 cc of 0.5% hyperbaric bupivacaine solution in the sitting position. Epidural block was applied to the patients in Group E using the median approach and loss of resistance method. After clarification that we were in the epidural space after aspiration and test dose, the drug was administered. A total of 20 cc drug mixture was prepared as 13 cc 65 mg marcain, 5 cc 100 mg arrhythmic and 2 cc 10 mcg fentanyl. During the operation, hemodynamic parameters were recorded every 5 minutes by noninvasive methods. In order to evaluate the stress and inflammatory response, venous blood samples were taken from all patients preoperatively, intraoperatively, postoperatively at the 1st hour and at the postoperative 12th hour. The samples were sent to the Clinical Biochemistry laboratory immediately after collection. Hemogram parameters were studied from blood samples. Findings: Age and duration of surgery from the demographic data of the patients were found to be significantly higher in the epidural anesthesia group than in the spinal anesthesia group. The rate of performing URS in the spinal anesthesia group was significantly higher than in the other groups. In the comparison of NLR, PLO and MPV values both within and between groups, significant changes were observed in the postoperative time periods. NLR and PLR values in the spinal anesthesia group were found to be significantly lower in the postoperative period compared to the other groups. It was observed that MPV values decreased in different postoperative time periods. Conclusion: As a result of this study, it was observed that spinal anesthesia, which is one of the anesthesia methods used in URS and RIRC surgeries, increased less in the postoperative period in the inflammatory parameters we looked at. We think that this is positive in terms of postoperative mortality and wound infection development, and that spinal anesthesia can be preferred compared to other anesthesia methods, especially in patients with cardiovascular disease. Keywords: NLO, PLO, MPV, Inflammation, General Anesthesia, Spinal Anesthesia, Epidural Anesthesia, URS, RIRC