ArticleJournal of pain research2026
Preoperative Neutrophil-to-Lymphocyte Ratio and PCA-Derived Opioid Demand After Laparoscopic Gynecologic Surgery.
Article in Journal of pain research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
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 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.
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