Purpose: Postoperative pain is a common and distressing issue following surgical procedures. The neutrophil-tolymphocyte ratio (NLR), which increases during the inflammatory response, is an important indicator influencing the severity of pain. Preemptive analgesia aims to reduce spinal sensitization by administering analgesics before surgery.This study investigates the effect of preoperative intravenous ibuprofen on postoperative pain in patients with high NLRs undergoing laparoscopic cholecystectomy. Methods: The study was conducted as a prospective, randomized, double-blind, placebo-controlled trial. A total of 73 patients aged 18–65 years with American Society of Anesthesiologists physical status I, II were included. Patients were divided into 2 groups based on their NLRs: high (>2) and low (<2). Each group was further divided into subgroups receiving preemptive analgesia (400 mg intravenous ibuprofen) or placebo. Pain levels were measured using the visual analogue scale (VAS), and rescue analgesia requirements were recorded. Results: VAS scores and rescue analgesia needs were significantly lower in patients receiving preemptive ibuprofen compared to the placebo group, regardless of the NLR. However, the inflammatory score did not have a statistically significant effect on postoperative pain or analgesic needs. There were no differences in operative time or discharge duration between groups. Conclusion Preemptive ibuprofen is an effective method for reducing postoperative pain and may decrease opioid consumption. The effects of preemptive analgesia were observed even in patients with high inflammatory scores. Studies with larger sample sizes could improve the generalizability of these findings.

BACKGROUND: Familial Mediterranean fever (FMF) is an autoinflammatory disease that has self-limiting inflammatory attacks during polyserositis. Hepcidin is a protein, and interleukin-6 stimulation increases hepcidin levels. Calprotectin (CLP) is a recently defined cytokine released from monocytes and neutrophils in response to tissue trauma and inflammation. There are studies in the literature showing that it can be used as a biomarker in rheumatic diseases such as ankylosing spondylitis and rheumatoid arthritis. Here, we compared the levels of hepcidin and CLP in healthy individuals and FMF patients during an attack-free period and show its relation to genetic mutations.METHODS: This is a cross-sectional study. Between July 2017 and December 2017, 60 patients diagnosed with FMF an admitted to the Cumhuriyet University Faculty of Medicine Department of Internal Medicine Rheumatology as well as 60 healthy volunteers without any rheumatic, systemic, or metabolic diseases were enrolled in this study. Blood was collected from a peripheral vein to measure serum CLP and hepcidin levels. Blood tests were examined by ELISA; the study protocol was approved by the local ethics committee.RESULTS: Median serum hepcidin level was 468.1 (210.3–807.8) pg/mL in FMF group and 890.0 (495.0–1,716.9) pg/mL in the healthy control (HC) group. There was a statistically significant difference between the two groups (P < 0.001). The median serum levels of CLP in the FMF group were measured as 1,331.4 (969.3–1,584.6 pg/mL and 73.8(45.0–147.9) pg/mL in the HC group. There was a statistically significant difference between the two groups (P < 0.001). Receiver operating characteristic analysis showed that the sensitivity was 66.7% and the specificity was 71.7% at serum hepcidin < 581.25 pg/mL (P < 0.05); the sensitivity was 96.7% and specificity was 100% at CLP > 238 pg/mL (P < 0.05). There was no significant difference between serum hepcidin and CLP levels in FMF patients with M694V homozygous and M694V heterozygous (P > 0.05). There was no significant difference in serum hepcidin levels between FMF patients with and without arthritis, proteinuria, and amyloidosis (P < 0.05). There was no significant correlation between laboratory findings, gender, age, and serum CLP and hepcidin levels (P > 0.05, r < 0.25).CONCLUSION: Serum CLP levels in FMF patients during an attack-free period are significantly higher than in the HC groups. Serum hepcidin levels in FMF patients are significantly lower than in the HC group. Low levels of hepcidin may be explained by including FMF patients during an attack-free period in the study. CLP may be an important biomarker in FMF. A better understanding of the role of these biomarkers in the diagnosis of FMF is needed to evaluate the results in a more comprehensive way.