SavedAdd your journal

Journals / Osmangazi Tıp Dergisi / 2025 / Cilt: 47 Sayı: 5

The Effect of Femoral Nerve Block on the Neutrophil-to Lymphocyte Ratio in Total Knee Arthroplasty

Total Diz Artroplastisinde Femoral Sinir Bloğunun Nötrofil Lenfosit Oranı Üzerine Etkisi

Nuran Akıncı Ekinci(konya şehir hastanesi)0000-0003-3269-3481
Esma Karaarslan(Sağlık Bilimleri Üniversitesi, Konya Şehir Hastanesi)0000-0002-3459-0243
Mahmut Sami Tutar(Sağlık Bilimleri Üniversitesi, Konya Şehir Hastanesi)0000-0002-5709-6504
Ahmet Yıldırım(Sağlık Bilimleri Üniversitesi, Konya Şehir Hastanesi)0000-0002-3953-091X
Pages
796–802
Publication Date
2025-09-04
🏛️Bibliographic metadata and full text access for this article are provided via DergiPark.
DergiPark Record ↗
✨

AI Summary & Key Takeaways

AI Insight
⚡ TL;DR(Too Long; Didn't Read)

These findings suggest that FNB may enhance recovery beyond analgesia by modulating the surgical stress response.

📌 3 Key Takeaways

🎯
Objective & Hypothesis:This study investigated whether femoral nerve block (FNB) reduces postoperative systemic inflammation, as measured by the neutrophil-to-lymphocyte ratio (NLR), in patients undergoing total knee arthroplasty (TKA) under spinal anesthesia.
📊
Key Findings & Data:In this retrospective cohort study, data from 199 patients who underwent unilateral TKA between January 1 and December 1, 2024, were analyzed.
💡
Conclusion & Impact:These findings suggest that FNB may enhance recovery beyond analgesia by modulating the surgical stress response.
🔬Design:Klinik Araştırma
📍Scope:2024 Verileri
⚙️Variables:Total diz artroplastisi · femoral sinir bloğu · nötrofil lenfosit oran

Abstract

This study investigated whether femoral nerve block (FNB) reduces postoperative systemic inflammation, as measured by the neutrophil-to-lymphocyte ratio (NLR), in patients undergoing total knee arthroplasty (TKA) under spinal anesthesia. It was hypothesized that FNB would mitigate the inflammatory response by alleviating pain and surgical stress. In this retrospective cohort study, data from 199 patients who underwent unilateral TKA between January 1 and December 1, 2024, were analyzed. Patients were divided into two groups: Group F (n=97), who received spinal anesthesia combined with femoral nerve block (FNB), and Group C (n=102), who received spinal anesthesia with standard analgesia only. Preoperative and 24-hour postoperative NLR values were obtained from complete blood counts. Statistical analysis was performed using IBM SPSS Statistics 26.0. The independent samples t-test or Mann-Whitney U test was used, depending on data distribution. Baseline NLR values were similar between groups (Group C: 1.85, Group F: 2.08; p=0.255). Postoperatively, NLR increased significantly in both groups; however, the increase was significantly lower in Group F (Group C: 9.15 vs. Group F: 5.58; p<0.001). The percentage increase in NLR was 356.58% in Group C and 170.99% in Group F (p<0.001), indicating a markedly attenuated inflammatory response in patients receiving FNB. FNB significantly reduces the postoperative rise in NLR in patients undergoing TKA under spinal anesthesia. This effect may result from both superior pain control and the anti-inflammatory properties of local anesthetics. These findings suggest that FNB may enhance recovery beyond analgesia by modulating the surgical stress response.

Özet

Bu çalışma, spinal anestezi altında total diz artroplastisi (TDA) uygulanan hastalarda femoral sinir bloğunun (FSB) nötrofil lenfosit oranı (NLR) üzerindeki etkisini incelemeyi hedeflemiştir. NLR, cerrahi sonrası sistemik inflamasyonun bir göstergesi olarak kullanılmıştır. FSB’nin postoperatif ağrı ve stres yanıtını azaltarak inflamasyonu hafifleteceği ve NLR’de düşüş sağlayacağı iddia edilmektedir. Yöntemler: Retrospektif kohort analizi, 1 Ocak 2024 - 1 Aralık 2024 tarihleri arasında tek taraflı TDA geçiren 199 hasta. Grup F (n=97): Spinal anestezi + FSB uygulanan hastalar, Grup K (n=102): Sadece spinal anestezi ile standart analjezi alan hastalar. Preoperatif ve postoperatif 24. saatte NLR değerleri tam kan sayımından hesaplandı. İstatistiksel analizler için IBM SPSS Statistics 26.0 (IBM Corp., Armonk, NY, ABD) yazılımı kullanıldı. Grupların karşılaştırılmasında; verilerin dağılımına göre bağımsız örneklem t testi veya Mann-Whitney U testi kullanıldı. Preoperatif NLR gruplar arasında benzerdi (Grup K: 1.85, Grup F: 2.08, p=0.255). Postoperatif NLR: Grup K’da 9.15’e yükselirken Grup F’de 5.58 olarak kaldı (p

🔖

Cite This Article

Ekinci, N. A., Karaarslan, E., Tutar, M. S., Yıldırım, A., *, N. A. E. (2025). The Effect of Femoral Nerve Block on the Neutrophil-to Lymphocyte Ratio in Total Knee Arthroplasty. Osmangazi Tıp Dergisi, Cilt: 47 Sayı: 5, 796–802. https://doi.org/10.20515/otd.1719750

📄 Full Text PDF Viewer

📄

PDF görüntüleyici hazırlanıyor...

References (18)

  1. Li JW, Ma YS, Xiao LK. Postoperative Pain Management in Total Knee Arthroplasty. Orthop Surg. 2019;11(5):755-761.
  2. Fillingham, Y. A., Hannon, C. P., Kopp, S. L., Austin, M. S., Sershon, R. A., Stronach, B. M.,. & Della Valle, C. J. (2022). The efficacy and safety of regional nerve blocks in total knee arthroplasty: systematic review and direct meta-analysis. The Journal of arthroplasty, 37(10), 1906-1921.
  3. Chan EY, Fransen M, Parker DA, Assam PN, Chua N. Femoral nerve blocks for acute postoperative pain after knee replacement surgery. Cochrane Database Syst Rev. 2014;2014(5):CD009941.
  4. Duarte, V. M., Fallis, W. M., Slonowsky, D., Kwarteng, K., & Yeung, C. K. (2006). Effectiveness of femoral nerve blockade for pain control after total knee arthroplasty. Journal of PeriAnesthesia Nursing, 21(5), 311-316.
  5. Yamada T, Hasegawa-Moriyama M, Kurimoto T, Saito T. Peripheral Nerve Block Facilitates Acute Inflammatory Responses Induced by Surgical Incision in Mice. Reg Anesth Pain Med. 2016;41(2):171- 176.
  6. Aguirre J, del Moral A, Cobo I, Blumenthal S. The role of continuous peripheral nerve blocks. Anesthesiol Res Pract. 2012;2012:560879.
  7. Köksal BG, Bollucuoğlu K, Şahin E, Bayram MG, Küçükosman G, Ayoğlu H. The effect of anesthesia methods on the neutrophil–lymphocyte ratio in patients undergoing forearm surgery: A monocentric and retrospective study. Medicine (Baltimore). 2024;103(43):e40290.
  8. Zahorec R. Ratio of neutrophil to lymphocyte counts – rapid and simple parameter of systemic inflammation and stress in critically ill. Bratisl Lek Listy. 2001;102(1):5-14.
  9. Islam MM, Satici MO, Eroglu SE. Unraveling the clinical significance and prognostic value of the neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, systemic immune-inflammation index, systemic inflammation response index, and delta neutrophil index: An extensive literature review. Turk J Emerg Med. 2024;24(1):8-19.
  10. Shah N, Parikh V, Patel N, Patel N, Badheka A, Deshmukh A, et al. Neutrophil lymphocyte ratio significantly improves the Framingham risk score in prediction of coronary heart disease mortality: Insights from the national health and nutrition examination survey-III. Int J Cardiol 2014;171:390-7.
  11. Dentali F, Nigro O, Squizzato A, Gianni M, Zuretti F, Grandi AM, et al. Impact of neutrophils to lymphocytes ratio on major clinical outcomes in patients with acute coronary syndromes: A systematic review and meta-analysis of the literature. Int J Cardiol 2018;266:31-7.
  12. Howard R, Kanetsky PA, Egan KM. Exploring the prognostic value of the neutrophil-to-lymphocyte ratio in cancer. Sci Rep 2019;9:19673.
  13. Drăgoescu AN, Pădureanu V, Stănculescu AD, Chiuțu LC, Tomescu P, Geormăneanu C, et al. Neutrophil to lymphocyte ratio (NLR)-a useful tool for the prognosis of sepsis in the ICU. Biomedicines 2021;10:75.
  14. Hwang SY, Shin TG, Jo IJ, Jeon K, Suh GY, Lee TR, et al. Neutrophil-to-lymphocyte ratio as a prognostic marker in critically-ill septic patients. Am J Emerg Med 2017;35:234-9.
  15. Forget P, Khalifa C, Defour JP, Latinne D, Van Pel MC, De Kock M. What is the normal value of the neutrophil-to-lymphocyte ratio? BMC Res Notes. 2017;10(1):12.
  16. Hadimioglu N, Ertug Z, Yegin A, et al. Comparison of the effects of general and spinal anesthesia on the inflammatory response in cesarean section. J Anesth. 2009;23(1):34-40.
  17. Riché, F., Gayat, E., Barthélémy, R., Le Dorze, M., Matéo, J., & Payen, D. (2015). Reversal of neutrophil-to-lymphocyte count ratio in early versus late death from septic shock. Critical Care, 19, 1-10.
  18. Surhonne N, Hebri C, Kannan S, Duggappa D, Rs R, Mapari CG. The effect of anesthetic techniques on neutrophil to lymphocyte ratio in patients undergoing infraumbilical surgeries. Korean J Anesthesiol. 2019;72:458-465.