Neutrophil lymphocyte ratio predicts postoperative pain after orthognathic surgery

Postoperative pain is well known and usually disturbing complication of surgery. Inflammation plays an important role in the development and progression of postoperative pain. We aimed to investigate possible relationship between preoperatively measured neutrophil-lymphocyte ratio (NLR) - as an inflammation marker - and postoperative analgesic demand in patients underwent orthognathic surgery.

We retrospectively investigated medical and anesthesia records of 177 patients underwent orthognathic surgery. Demographical data, preoperative NLR, type of surgery, modified Mallampati score, difficulty degree of intubation, duration of surgery, and postoperative analgesic (tenoxicam - as the first drug of choice, paracetamol, tramadol, or pethidine) usage were recorded. A cutoff value of NLR ≥2 was determined for inflammation threshold. Two groups (Group 1 NLR ≥2, Group 2 NLR <2) were compared for analgesic doses, numbers of patients needed analgesic treatment, and other parameters.

Mean administered tenoxicam dose was significantly higher in Group 1 than in Group 2 (P < 0.0001). Further, ratio of patients treated with tenoxicam in Group 1 was significantly higher than that in Group 2 (χ2 = 4.779, P = 0.029).

Preoperatively measured NLR may help to predict postoperative analgesic demand in patients undergoing orthognathic surgery, and thus sufficient postoperative pain control can be achieved with various preventive treatments taken at the perioperative period such as preemptive analgesia, local anesthetic administration at the end of surgery, or early administration of analgesics.