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Preoperative Neutrophil-to-Lymphocyte Ratio and PCA-Derived Opioid Demand After Laparoscopic Gynecologic Surgery
1Department of Anesthesiology and Reanimation, Karadeniz Technical University Faculty of Medicine Hospital, Trabzon, Türkiye.
Purpose:
To evaluate whether preoperative neutrophil-to-lymphocyte ratio (NLR) is associated with early postoperative pain burden and PCA-derived opioid requirement after laparoscopic gynecologic surgery.
Methods:
In this prospective observational study, 59 ASA I-III adults undergoing laparoscopic gynecologic surgery were grouped using a predefined preoperative NLR threshold as <2 (Group 1, n=32) or ≥2 (Group 2, n=27). Included procedures were laparoscopic hysterectomy, myomectomy, tubal ligation, salpingectomy, cystectomy, and ovarian torsion surgery. Pain was assessed using the numeric rating scale (NRS) at 2, 4, 12, and 24 hours. PCA logs were used to quantify attempted demands, delivered boluses, failed attempts, attempted-to-delivered bolus ratio, and 24-hour PCA-delivered bolus fentanyl consumption. ROC and regression analyses were interpreted as exploratory.
Results:
Group 2 had higher 24-hour PCA-delivered bolus fentanyl consumption than Group 1 (240.01 ± 79.72 vs 158.43 ± 64.94 µg, p<0.001), with greater attempted demands, delivered boluses, failed attempts, and attempted-to-delivered bolus ratio (all p≤.013). Weight-adjusted PCA-delivered bolus fentanyl consumption was also higher in Group 2 (3.22 ± 1.02 vs 2.24 ± 0.86 µg/kg, p<0.001). NRS scores were higher in Group 2 at all postoperative time points (all p<0.05). In exploratory ROC analysis, preoperative NLR showed an AUC of 0.782 (95% CI 0.641-0.903; p=0.001), with a ROC-derived cutoff of 2.02. Preoperative NLR ≥2 was associated with high opioid requirement after adjustment for age and body mass index (adjusted OR 7.14, 95% CI 1.64-31.09; p=0.009). In multivariable linear regression, preoperative NLR remained associated with 24-hour PCA-delivered bolus fentanyl consumption (β=30.54, 95% CI 8.56-52.52; p=0.007).
Conclusion:
Higher preoperative NLR was associated with greater early postoperative pain burden and PCA-derived opioid requirement. Given the single-center design and modest sample size, the clinical utility of the NLR threshold requires validation in larger independent cohorts.
