Relationship Between Acute Phase Markers and Acute Post-operative Pain in Laparoscopic Cholecystectomy: An Observational Study
Conditions: Post Operative Pain
Sponsor: University of Roma La Sapienza

Relationship Between Acute Phase Markers and Post-operative Pain in 
Laparoscopic Cholecystectomy: An Observational Study 
  
 
 
March 3, 2023 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Background: Many patients undergoing laparoscopic cholecystectomy are prone to 
developing acute and chronic post-operative pain.  
The aim of the study is to show a possible correlation between pain and acute phase 
proteins in order to: 
 
predict the severity of pain; 
 
select most suitable pain relief therapy for the patient. 
Materials and methods: The day after surgery, some serum markers are determined by a 
blood sample. The markers analyzed are: 
 
Leukocytes; 
 
C-reactive protein (CRP); 
 
D-dimer; 
 
Fibrinogen; 
 
Neutrophil-to-Lymphocyte Ratio (NLR). 
Pain level is assessed using the NRS scale at different times: 
 
1st post-operative day; 
 
7th post-operative day; 
 
One month after surgery; 
 
Three months after surgery; 
 
Six months after surgery. 
Other data collected for the study are: gender, age and BMI. 
SAP: Statistical Analysis Plan was expressed as percentages, median, and range of 
values. Differences between continuous variables were analyzed with the Mann-Whitney U 
test, whereas differences between categorical variables were evaluated with the chi-
square or the Fisher’s exact test, when appropriate. Variables achieving statistical 
significance (P<0.05) at univariate analysis were entered in a backward multivariate 
logistic regression model, removing the variable if P more than 0.10. P less than 0.05 was 
considered statistically significant. Statistical analysis was carried out with the SPSS 
software packaging (SPSS Inc., Chicago, IL), version 13. 
References 
1. Rathee A, Chaurasia MK, Singh MK, Singh V, Kaushal D. Relationship Between 
Pre- and Post-Operative C-Reactive Protein (CRP), Neutrophil-to-Lymphocyte Ratio 
(NLR), and Platelet-to-Lymphocyte Ratio (PLR) With Post-Operative Pain After 
Total Hip and Knee Arthroplasty: An Observational Study. Cureus. 2023 Aug 
20;15(8):e43782. doi: 10.7759/cureus.43782. eCollection 2023 Aug.   PubMed ID: 
37731439 
2. Shu B, Xu F, Zheng X, Zhang Y, Liu Q, Li S, Chen J, Chen Y, Huang H, Duan G. 
Change in perioperative neutrophil-lymphocyte ratio as a potential predictive 
biomarker for chronic postsurgical pain and quality of life: an ambispective 
observational cohort study. Front Immunol. 2023 Apr 12;14:1177285. doi: 
10.3389/fimmu.2023.1177285. eCollection 2023.   PubMed ID: 37122722 
3. Gonzalez-Callejas C, Aparicio VA, De Teresa C, Nestares T. Association of Body 
Mass Index and Serum Markers of Tissue Damage with Postoperative Pain. The 
Role of Lactate Dehydrogenase for Postoperative Pain Prediction. Pain Med. 2020 
Aug 1;21(8):1636-1643. doi: 10.1093/pm/pnz325.   PubMed ID: 31845982