Öner Kerim, Okutan Ahmet Emin, Ayas Muhammet Salih, Paksoy Ahmet Emre, Polat Ferdi
Yozgat Bozok University, School of Medicine, Orthopaedics and Traumatology Dept., Yozgat, Turkey.
Karadeniz Technical University, School of Medicine, Orthopaedics and Traumatology Dept., Trabzon, Turkey.
Asia Pac J Sports Med Arthrosc Rehabil Technol. 2020 Mar 17;20:24-27. doi: 10.1016/j.asmart.2020.03.001. eCollection 2020 Apr.
Postoperative pain is well known and usually disturbing complication of arthroscopic shoulder surgery. Inflammation plays an important role in the development and progression of postoperative pain. The aim of this study was to evaluate the predictability of postoperative pain through the correlation of neutrophil/lymphocyte ratio (NLR) with inflammation. In addition, the correlation of parameters such as operative time, tear size, age and gender with postoperative pain was evaluated.
Sixty three patients, who underwent arthroscopic rotator cuff repair, were evaluated in this single-center-based retrospective study. The American Society of Anaesthesiologists I and II risk groups were determined as the inclusion criteria. NLR was calculated using preoperative one day hemogram values in all patients. The amounts of analgesic use and Numerical Rating Scale (NRS) scores at the 12th, 24th and 48th hours and on the 3rd and 7th days were recorded. Multivariate linear regression analysis was used to correlate postoperative NRS scores with multiple independent factors, including preoperative NLR, sex, age, tear size, repair type, operative time, block time, postoperative analgesic intake and length of hospital stay.
Sixty three patients with a mean age of 59.4 years (range, 40-72 years) were evaluated. The mean tear size was 2.8 cm (range, 1-5 cm), the mean operative time was 84.1 min (range, 35-135 min), the mean duration of block was 7.6 hours (range, 4-12 hours) and the mean length of hospital stay was 1.7 days (range, 1-3 days). There was no significant correlation between age, sex, tear size, repair type, operative time and postoperative NRS (p > 0.2). The preoperative NLR was found to be a strong predictor of postoperative NRS (p < 0.001, rho = 0,864). There was a correlation between the NLR and mean analgesic intake (p = 0,03). The duration of block was decreased in patients with a NLR above 2, while it was prolonged in patients with a NLR below 2 (p = 0.04, rho = -0,725).
The preoperative NLR was found to be a strongest factor predicting high acute pain levels after arthroscopic rotator cuff surgery. Likewise, NLR was also predictive of postoperative block time and analgesic consumption.
术后疼痛是关节镜下肩部手术常见且通常令人困扰的并发症。炎症在术后疼痛的发生和发展中起重要作用。本研究的目的是通过中性粒细胞/淋巴细胞比值（NLR）与炎症的相关性来评估术后疼痛的可预测性。此外，还评估了手术时间、撕裂大小、年龄和性别等参数与术后疼痛的相关性。
在这项基于单中心的回顾性研究中，对63例行关节镜下肩袖修复术的患者进行了评估。将美国麻醉医师协会I级和II级风险组确定为纳入标准。所有患者均使用术前一天的血常规值计算NLR。记录第12、24和48小时以及第3天和第7天的镇痛药物使用量和数字评分量表（NRS）评分。采用多变量线性回归分析将术后NRS评分与多个独立因素相关联，这些因素包括术前NLR、性别、年龄、撕裂大小、修复类型、手术时间、阻滞时间、术后镇痛药物摄入量和住院时间。
对63例平均年龄为59.4岁（范围40 - 72岁）的患者进行了评估。平均撕裂大小为2.8 cm（范围1 - 5 cm），平均手术时间为84.1分钟（范围35 - 135分钟），平均阻滞时间为7.6小时（范围4 - 12小时），平均住院时间为1.7天（范围1 - 3天）。年龄、性别、撕裂大小、修复类型、手术时间与术后NRS之间无显著相关性（p > 0.2）。术前NLR被发现是术后NRS的有力预测指标（p < 0.001，rho = 0.864）。NLR与平均镇痛药物摄入量之间存在相关性（p = 0.03）。NLR高于2的患者阻滞时间缩短，而NLR低于2的患者阻滞时间延长（p = 0.04，rho = -0.725）。
术前NLR被发现是关节镜下肩袖修复术后预测高急性疼痛水平的最强因素。同样，NLR也可预测术后阻滞时间和镇痛药物消耗量。
