Effect of intravenous glutamine supplementation on postoperative fatigue following major oncological surgery of the digestive tract. A prospective trial

Introduction: The aim of the study was to evaluate the effects of postoperative administration of glutamine on the subjective perception of fatigue after major surgery. A prospective controlled clinical trial was conducted with a quasi-randomization method, enrolling cancer patients undergoing major elective surgery and treated with intravenous glutamine supplementation. Materials and Methods: Twenty-two well-nourished or slightly undernourished cancer patients were enrolled and divided into 2 groups. Both groups received isocaloric and protein-sparing nutritional support (1215 Kcal; 7.3 g N) by a peripheral parenteral nutrition device for 7 days after the operation. The glutamine group also received an intravenous glutamine supplement (20 g/day) on the first 6 postoperative days. We measured biochemical, clinical and anthropometric parameters including prealbumin, albumin, retinol-binding protein, transferrin, C-reactive protein, lymphocytes, fatigue (by visual analogue scale), handgrip force (by dynamometer), weight, height, mid-arm circumference and triceps skinfold thickness. Results: Each group was analyzed for significant values with Student's t-test. A better response of transferrin and retinol-binding protein was measured in the glutamine group (p<0.05). Within each group, the time course of parameters was analyzed. The results were presented in the form of a paired t-test and showed a favorable trend for prealbumin, albumin and mid-arm circumference. A controversial result was obtained during the first postoperative days for C-reactive protein and postoperative fatigue. Conclusions: Glutamine supplementation in well-nourished or slightly undernourished cancer patients undergoing major elective surgery does not seem to improve postoperative fatigue, but ameliorates biohumoral recovery and nutritional status after major surgery. © 2014 SINPE-GASAPE.