Indian Journal of Gastroenterology

, Volume 37, Issue 6, pp 511–519 | Cite as

Study of glutathione S-transferase levels in patients receiving intravenous paracetamol perioperatively: A randomized controlled trial

  • Satyen ParidaEmail author
  • Ramesh Panga
  • Medha Rajappa
  • Pankaj Kundra
Original Article


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.


Glutathione 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.

Ethical clearance

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

Informed consent

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.


  1. 1.
    Denno R, Takabayashi A, Sugano M, et al. The ratio of reduced glutathione/oxidized glutathione is maintained in the liver during short-term hepatic hypoxia. J Gastroenterol. 1995;30:338–46.CrossRefGoogle Scholar
  2. 2.
    Sherman M, Bass NM, Campbell JA, Kirsch RE. Radioimmunoassay of human ligandin. Hepatology. 1983;3:162–9.CrossRefGoogle Scholar
  3. 3.
    Ketley JN, Habig WH, Jakoby WB. Binding of nonsubstrate ligands to the glutathione S-transferases. J Biol Chem. 1975;250:8670–3.Google Scholar
  4. 4.
    Bass NM, Kirsch RE, Tuff SA, Saunders SJ. Radioimmunoassay of plasma ligandin: a sensitive index of experimental hepatocellular necrosis. Gastroenterology. 1978;75:589–94.Google Scholar
  5. 5.
    Hayes PC, Bouchier IA, Beckett GJ. Glutathione S-transferase in humans in health and disease. Gut. 1991;32:813–8.CrossRefGoogle Scholar
  6. 6.
    Watkins PB, Kaplowitz N, Slattery JT, et al. Aminotransferase elevations in healthy adults receiving 4 grams of acetaminophen daily a randomized controlled trial. JAMA. 2006;296:87–93.CrossRefGoogle Scholar
  7. 7.
    Dart RC, Bailey E. Does therapeutic use of acetaminophen cause acute liver failure? Pharmacotherapy. 2007;27:1219–30.CrossRefGoogle Scholar
  8. 8.
    Hayward KL, Powell EE, Irvine KM, Martin JH. Can paracetamol (acetaminophen) be administered to patients with liver impairment? Br J Clin Pharmacol. 2016;81:210–22.CrossRefGoogle Scholar
  9. 9.
    Sabaté M, Ibáñez L, Pérez E, et al. Paracetamol in therapeutic dosages and acute liver injury: causality assessment in a prospective case series. BMC Gastroenterol. 2011;11:80.CrossRefGoogle Scholar

Copyright information

© Indian Society of Gastroenterology 2018

Authors and Affiliations

  1. 1.Department of Anesthesiology and Critical CareJawaharlal Institute of Postgraduate Medical Education and ResearchPuducherryIndia
  2. 2.Department of BiochemistryJawaharlal Institute of Postgraduate Medical Education and ResearchPuducherryIndia

Personalised recommendations