J Med Assoc Thai 2018; 101 (9):1145-50

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Outcomes after Postoperative Amino Acid Supplementation in Patients Undergoing Elective Upper and Lower Gastrointestinal Tract Surgery: Randomized Controlled Trial
Eurboonyanun C Mail, Sripanaskul A , Ruangwannasak S , Sathitkarnmanee E , Srisuk T , Aphinives P , Posri S

Background: Surgical patients in a catabolic phase will affect vital functions such as the respiratory mechanism. Peripheral parenteral nutrition with amino acids can reduce fat and protein breakdown and preserve the protein sparing effect resulting in better outcomes. Due to financial limitations, most Thai surgical patients receive only peripheral venous feeding with glucose alone, without amino acids.

Objective: To investigate the postoperative nitrogen balance among Thai surgical patients receiving elective gastrointestinal surgery with different peripheral intravenous feeding.

Materials and Methods: Thirty-six post-elective gastrointestinal surgery patients were enrolled in an open labeled, prospective, randomized controlled trial. Patients received 3% amino acid with 7.5% dextrose (n = 12), 5% dextrose (n = 12), or 10% dextrose (n = 12). From the first postoperative day, the peripheral venous solutions were infused into the three groups for 72 hours. The nitrogen balance was assessed by collecting 24 hours urine on the first and third post-operative day. Markers for protein metabolism were investigated (viz., pre-albumin, transferrin, and blood urea nitrogen).

Results: The nitrogen balance on the first and third post-operative day were observed in all groups. There was significantly improvement after 3% amino acid plus 7.5% dextrose infusion (-1.37, -2.47), compared with either 10% dextrose (-8.53, -7.04), or 5% dextrose (-8.76, -7.90) infusion. Length of stay, serum transferrin, and serum pre-albumin made no significant difference among the three groups.

Conclusion: Three percent amino acids plus 7.5% dextrose reduced post-operative negative nitrogen balance in gastrointestinal tract surgical patients without any serious complications.

Keywords: Randomized controlled trial, RCT, Amino acid, Peripheral parenteral nutrition

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