Study of glutathione S-transferase levels in patients receiving intravenous paracetamol perioperatively: A randomized controlled trial
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Background and Aims
Many studies have analyzed the effect of paracetamol on liver functions. The aim of this study was to measure glutathione S-transferase (GST) concentrations in patients receiving intravenous (IV) paracetamol infusions as part of their perioperative pain relief regimen to assess its effect on hepatocellular integrity.
Patients between the ages of 18 and 60 years of both sexes, of American Society of Anesthesiologists (ASA) grades 1 and 2, undergoing laparoscopic gastrointestinal (GI) surgeries were included in the study. Patients in the saline group received three doses of normal saline as placebo 8 h apart, with the first dose administered following the induction of anesthesia. Patients in the paracetamol group received IV paracetamol at identical time points. Blood samples were collected preoperatively, after 1, 6, and at 24 h after induction. GST levels were measured at baseline and after 1, 6, and 24 h in both the groups.
There was no statistical difference in the demographic variables between the groups. The duration and type of surgery were identical between both the groups. GST values were found to be significantly elevated both within groups, as compared to baseline, and also in the group receiving IV paracetamol as compared to the saline group. Significant elevations of liver enzymes and decrease in serum albumin levels were also noted both within and between the groups at 24 h postoperatively, as compared to the baseline values.
Intravenous paracetamol infusion during laparoscopic GI surgeries can lead to demonstrable, although subclinical impairment of hepatic function as evident by the rise in levels of GST and hepatic enzymes. Most of such subclinical injury did not progress to clinical hepatic impairment in otherwise healthy patients, as demonstrated by the fact that none of our patients manifested drug-induced hepatitis clinically.
KeywordsGlutathione S-transferase Intravenous paracetamol Laparoscopic surgery Liver enzymes Subclinical hepatic injury
This study was supported by an institutional funding from JIPMER, Puducherry (India).
Compliance with ethical standards
Conflicts of interest
SP, RP, MR, and PK declare that they have no conflict of interest.
The authors declare that the study was performed in a manner conforming to the Helsinki declaration of 1975, as revised in 2000 and 2008 concerning human and animal rights, and the authors followed the policy concerning informed consent as shown on Springer.com.
Research guidelines of the Institute Ethics Committee, JIPMER, Puducherry, India, for the protection of human subjects were followed. Consent was obtained from the patient after full explanation of the purpose, nature, and risks of all procedures used.
The authors are solely responsible for the data and the content of the paper. In no way, the Honorary Editor-in-Chief, Editorial Board Members, or the printer/publishers are responsible for the results/findings and content of this article.
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