Effects of different anesthetic techniques on neutrophil lymphocyte ratio and monocyte lymphocyte ratio in patients undergoing major non-cardiac surgery: A prospective, single-blind, randomized study

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.