Inflammatory Response Under Spinal vs General Anesthesia in PCNL: NLR, RDW, LAR.

Effects of Spinal Versus General Anesthesia on Perioperative Inflammatory Response in Percutaneous Nephrolithotomy (PCNL): The Role of Neutrophil-to-Lymphocyte Ratio (NLR), Red Cell Distribution Width (RDW), and Lactate-to-Albumin Ratio (LAR)

This observational study compares the effects of spinal versus general anesthesia on the perioperative systemic inflammatory response in adults undergoing PCNL. Routine clinical laboratory values (NLR, RDW, LAR) obtained preoperatively and postoperatively will be recorded to evaluate between-group and within-group changes. No additional blood sampling will be performed beyond standard care.

The study will be conducted at the Department of Anesthesiology and Reanimation, Elazığ Fethi Sekin City Hospital, among adult patients scheduled for PCNL (ASA I-III). The anesthesia type (spinal vs general) is determined by clinical requirements; investigators do not influence this choice.

Sampling windows:

Preoperative: within ≤6 hours before surgery

Postoperative: first sample obtained within 6-24 hours after surgery Parameters: NLR (neutrophil/lymphocyte), RDW, LAR; plus age, sex, ASA class, operative time, and in-hospital complications.

Statistics: Normality testing; between-group comparisons by independent t-test or Mann-Whitney U; within-group by paired t-test or Wilcoxon; categorical by chi-square; p<0.05 significant. Power considerations target ≥45 per group (total ≥90). No extra biospecimens will be collected beyond routine care.

Inclusion Criteria:

Age ≥18 years

ASA physical status I-III

Scheduled for percutaneous nephrolithotomy (PCNL)

Provided informed consent

Exclusion Criteria:

Active infection or sepsis

Known malignancy

Chronic inflammatory or autoimmune disease (e.g., rheumatoid arthritis, systemic lupus erythematosus)

Current immunosuppressive therapy

Pregnancy