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Background <p>As the number of total knee arthroplasties (TKA) continues to rise worldwide, effective postoperative pain management remains a major clinical priority. Poor early pain control can delay recovery, impede mobilization, and increase the risk of persistent pain. Identification of simple preoperative predictors of postoperative pain and opioid requirements may facilitate individualized analgesic management. This study, therefore, investigated whether the preoperative neutrophil-to-lymphocyte ratio (NLR), a marker of systemic inflammation, was associated with pain intensity and opioid consumption during the first three postoperative days after TKA.</p> Methods <p>A retrospective study was performed by reviewing perioperative records of patients undergoing TKA. Adult patients (≥ 18&#xa0;years) undergoing primary unilateral TKA under general anesthesia with American Society of Anesthesiologists (ASA) physical status&#xa0;I-III were included. Exclusion criteria were revision or bilateral TKA, inflammatory or autoimmune disease, ongoing infection, preoperative chronic opioid use or immunosuppressive therapy, and incomplete clinical records. Patients were divided into two groups based on their preoperative NLR (NLR ≤ 2 vs NLR &gt; 2), according to previously published literature. Postoperative pain was assessed using the 0–10 numerical rating scale (NRS) on postoperative days&#xa0;1–3, where 0&#xa0;indicates no pain and 10&#xa0;the worst imaginable pain; scores of 1–3 were defined as mild, 4–6 as moderate and 7–10 as severe pain. We analyzed differences in analgesic dosages, NRS scores and other relevant parameters between the two groups.</p> Results <p>A total of 427 patients were analyzed. Preoperative NLR showed a significant positive correlation with postoperative NRS scores and sufentanil consumption (both&#xa0;<i>P</i> &lt; 0.001). Group&#xa0;2 (NLR &gt; 2) exhibited significantly higher median (Q1-Q3) sufentanil consumption compared to Group&#xa0;1 (NLR ≤ 2): 102.2 µg (89.0–118.7) vs 72.8&#xa0;µg (58.7–85.7), <i>P</i> &lt; 0.001. Higher NLR values were also associated with significantly greater median NRS scores for pain at rest and during movement.</p> Conclusions <p>Preoperative NLR may serve as a simple and cost-effective biomarker associated with increased postoperative pain and opioid consumption after TKA. Preoperative assessment of NLR may help identify patients at risk for greater pain and higher analgesic requirements, thereby facilitating individualized analgesic management. However, because these findings were derived from a retrospective single-center study, prospective multicenter studies are needed to validate the clinical utility of NLR, determine optimal cutoff values, and develop formal prediction models in accordance with TRIPOD guidelines.</p> Graphical abstract <p></p>

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Preoperative Neutrophil-to-Lymphocyte Ratio is Associated with Early Postoperative Pain and Opioid Consumption after Total Knee Arthroplasty: A Retrospective Study

  • 期刊论文

  • 发表日期：

    2026年5月11日

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  • Yonghong Ding,
  • Sufen Lu,
  • Huili Kan,
  • Zongwang Zhang

摘要

Background

As the number of total knee arthroplasties (TKA) continues to rise worldwide, effective postoperative pain management remains a major clinical priority. Poor early pain control can delay recovery, impede mobilization, and increase the risk of persistent pain. Identification of simple preoperative predictors of postoperative pain and opioid requirements may facilitate individualized analgesic management. This study, therefore, investigated whether the preoperative neutrophil-to-lymphocyte ratio (NLR), a marker of systemic inflammation, was associated with pain intensity and opioid consumption during the first three postoperative days after TKA.

Methods

A retrospective study was performed by reviewing perioperative records of patients undergoing TKA. Adult patients (≥ 18 years) undergoing primary unilateral TKA under general anesthesia with American Society of Anesthesiologists (ASA) physical status I-III were included. Exclusion criteria were revision or bilateral TKA, inflammatory or autoimmune disease, ongoing infection, preoperative chronic opioid use or immunosuppressive therapy, and incomplete clinical records. Patients were divided into two groups based on their preoperative NLR (NLR ≤ 2 vs NLR > 2), according to previously published literature. Postoperative pain was assessed using the 0–10 numerical rating scale (NRS) on postoperative days 1–3, where 0 indicates no pain and 10 the worst imaginable pain; scores of 1–3 were defined as mild, 4–6 as moderate and 7–10 as severe pain. We analyzed differences in analgesic dosages, NRS scores and other relevant parameters between the two groups.

Results

A total of 427 patients were analyzed. Preoperative NLR showed a significant positive correlation with postoperative NRS scores and sufentanil consumption (both P < 0.001). Group 2 (NLR > 2) exhibited significantly higher median (Q1-Q3) sufentanil consumption compared to Group 1 (NLR ≤ 2): 102.2 µg (89.0–118.7) vs 72.8 µg (58.7–85.7), P < 0.001. Higher NLR values were also associated with significantly greater median NRS scores for pain at rest and during movement.

Conclusions

Preoperative NLR may serve as a simple and cost-effective biomarker associated with increased postoperative pain and opioid consumption after TKA. Preoperative assessment of NLR may help identify patients at risk for greater pain and higher analgesic requirements, thereby facilitating individualized analgesic management. However, because these findings were derived from a retrospective single-center study, prospective multicenter studies are needed to validate the clinical utility of NLR, determine optimal cutoff values, and develop formal prediction models in accordance with TRIPOD guidelines.

Graphical abstract