The effect of preoperative neutrophyl/lymphocyte ratio on postoperative analgesic consumption among laparoscopic gynecological surgeries

THE EFFECT OF PREOPERATIVE NEUTROPHYL / LYMPHOCYTE RATIO ON POSTOPERATIVE ANALGESIC CONSUMPTION AMONG LAPAROSCOPIC GYNECOLOGICAL SURGERIES Introduction: Pain is the physiological response to a harmful stimulus; varies with the complex interaction between cognitive, behavioral and sociocultural parameters. Postoperative pain is an acute type of pain that begins with a surgical incision and gradually decreases with tissue healing. Post-surgical pain prolongs hospital stays for patients; is associated with increased mortality and morbidity. Gynecology operations, which constitute an important part of abdominal surgical interventions, are currently performed in two ways: open and laparoscopic surgeries. Laparoscopic procedures, which have become widespread in recent years, have distinct advantages compared to open surgery. Although pain is the most common postoperative problem in laparoscopic cholecystectomies, postoperative pain is less common than open cholecystectomies. Pharmacological agents commonly used in postoperative pain treatment are opioid analgesics, NSAIDs, local anesthetics and adjuvant medicines. By the effective and safe use of patient-controlled analgesia (PCA) as a popular approach in analgesia for years, the patient-controlled drug administration system, which provides the desire and satisfaction for patients, has become known as a well-defined method. In the PCA method, the patient's ability to administer the analgesic medicine and to control the pain reduces anxiety and stress, which are major factors in postoperative pain. In studies using opioids in PCA, recommended doses differ in each study. The neutrophil / lymphocyte ratio (NLR) has been used to determine the risk of postoperative nausea and vomiting, estimate postoperative morbidity, and cancer staging. In the present time, there are different studies showing that there is a correlation between the neutrophil / lymphocyte ratio and analgesic consumption. Objective: In our study, we aimed to examine the relationship between preoperative neutrophil/ lymphocyte ratio and postoperative analgesic consumption, and the relationship between preoperative neutrophil/ lymphocyte ratio and postoperative pain in laparoscopic gynecological operations. Materials and Methods: This study was carried out prospectively in 60 patients (with ASA I, II, ΙΙΙ), peformed gynecological laparoscopic surgery and their expected operation time between 30-180 minutes. The patients included in the study were divided into two groups according to the preoperative neutrophil/lymphocyte ratio: as the neutrophil/lymphocyte ratio was below two (Group 1) and above two (Group 2). 50/50% O2 / air and 2% sevoflurane gas mixture was used for maintenance of anesthesia in all patients, and analgesia was provided by remifentanil infusion during operations. Heart rate, oxygen saturation, mean arterial pressure, end-tidal carbon dioxide volume (EtCO₂), inspired oxygen values were recorded before induction, 0th,1st,5th,10th,60th minutes after intubation and just before extubation for all patients. Results: There was no statistically significancy between the mean age, weight, height, BMI, duration of anesthesia and operation time of the patients among the groups. There was a statistically significant difference between group 1 and group 2 in terms of the amount of analgesic demand and amount of analgesic administration (p <0.001). There was no statistically significant relationship between NRS values at different times and post N / L values. There was a moderate difference between preoperative NLR and postoperative 2nd, 4th, and 24th hour-NRS; and statistically weak difference with 12-hour NRS. (p <0.001, r = 0.482, p <0.001 r = 0.495, p <0.001 r = 0.467, p <0.001 r = 0.334, respectively) Conclusion: Postoperative analgesic requirement and postoperative pain levels were found to be higher in patients with preoperative neutrophil/ lymphocyte ratio above two (Group 2) in laparoscopic gynecological operations.