Effect of intra-operative amino acid infusion on recovery quality in patients undergoing open radical gastrectomy

Objective To investigate the effect of intra-operative infusion of amino acid on the postoperative recovery quality in patients undergoing gastrectomy.

Methods The patients who underwent open radical gastrectomy from January 2016 to June 2019 were enrolled in the study and randomly assigned into two groups. The patients in the amino acid group received 11.4% 18-compound amino acid-Ⅱ via the jugular vein at the rate of 2 mL·kg^-1·h^-1 for 2 h during surgery. The patients in the control group received normal saline at the same rate and time. Primary outcomes were extubation and recovery, and the recovery quality was assessed by QoR-15 and Richmond agitation-sedation scale (RASS). Secondary indexes were nasopharyngeal temperature, blood glucose level, neutrophil count, lymphocyte count, interleukin-6 (IL-6), and C reactive protein (CRP) 1st day after surgery. Postoperative complications and length of hospital stay were also recorded.

Results A total of 78 patients were enrolled, including 35 in the amino acid group and 43 in the control group. The extubation time was significantly earlier in the amino acid group than that in the control group (75, 10 min vs 12.510, 15 min, P < 0.001). The QoR-15 and RASS scores were significantly better in the amino acid group than those in the control group (P < 0.001). Nasopharyngeal temperatures during and after surgery were significantly lower in the control group than those in the amino acid group (P < 0.001). The levels of IL-6 and CRP in both groups 1 day after surgery were significantly higher than before surgery (P < 0.001); the IL-6 level of patient in the amino acid group was significantly higher than that in the control group 1 day after surgery (P=0.048). There was no significant difference in the levels of glucose, CRP, neutrophil count, lymphocyte count, postoperative nausea, and vomiting, shivering, infectious complications, etc., or length of hospital stay.

Conclusions Intra-operative infusion of amino acid during gastrectomy could improve the recovery quality and reduce the risk of hypothermia without increasing inflammatory or glucose level.