Key result
General anesthesia caused a significantly higher rise in mean neutrophil-to-lymphocyte ratio at 24 hours post-surgery compared to total intravenous anesthesia and combined spinal-epidural (P<0.001).
Why the study?
Various surgical and anesthetic techniques produce stress, and this study aimed to evaluate changes in neutrophil-to-lymphocyte ratio and monocyte-to-lymphocyte ratio at different time points in patients undergoing major surgery.
Do different anesthetic techniques (TIVA or CSE vs GA) affect the neutrophil-to-lymphocyte ratio and monocyte-to-lymphocyte ratio in patients undergoing major non-cardiac surgery?
RCT (n=300)
Single-blind
randomized
Do different anesthetic techniques (TIVA or CSE vs GA) affect the neutrophil-to-lymphocyte ratio and monocyte-to-lymphocyte ratio in patients undergoing major non-cardiac surgery?
p-value: p=<0.001
General anesthesia is associated with a higher stress response, indicated by a greater rise in neutrophil-to-lymphocyte ratio compared to TIVA or neuraxial blockade in major non-cardiac surgery.
NLR/MLR rises may signal anesthesia-related stress; leaves open whether ratios should guide technique selection in non-cardiac surgery.
Background: Various surgical and anesthetic techniques can produce stress. This study aimed to see the changes in neutrophil-to-lymphocyte ratio (NLR) and monocyte-to-lymphocyte ratio (MLR) in patients undergoing major surgery at different time points. Materials and Methods: A prospective randomized controlled single blinded study was conducted involving 300 patients, scheduled for elective non-cardiac surgeries, randomly grouped into Group 1 (general anesthesia [GA]), Group 2 (total intravenous anesthesia [TIVA]), and Group 3 (combined spinal and epidural [CSE]). Blood samples were collected for NLR and MLR (preoperatively, end-of-surgery, 6 and 24 h after surgery). Results: There was an increase in NLR in all three groups and increase in mean NLR was highest in group GA at the end of the surgery, 6 and 24 h after surgery. The mean comparison of NLR at 6 and 24 h after surgery was also found to be significant when comparison was made between groups 1 and 2 (P = 0.001), and between groups 1 and 3 (P < 0.001); however, the difference was found to be insignificant when comparison was made between groups 2 and 3. Conclusion: The mean comparison of NLR at 24 h after surgery was found to be significant when comparison was made between GA and TIVA, GA and CSE; however, the difference was insignificant between-TIVA and CSE groups. Highest rise in the mean NLR 24 h after surgery was found in patients who underwent surgeries under GA than TIVA followed by neuraxial blockade.
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Kumar et al. (2023) conducted an RCT in elective non-cardiac surgeries (n=300). General anesthesia (GA) vs. Total intravenous anesthesia (TIVA) and combined spinal and epidural (CSE) was evaluated on changes in neutrophil-to-lymphocyte ratio (NLR) and monocyte-to-lymphocyte ratio (MLR) (p=<0.001). General anesthesia caused a significantly higher rise in mean neutrophil-to-lymphocyte ratio at 24 hours post-surgery compared to total intravenous anesthesia and combined spinal-epidural (P<0.001).
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