Glutamine supplementation reduces hospitalization following elective surgeries

Surgeons now making glutamine supplementation a standard part of their perioperative protocol for general and orthopedic surgery patients.

Administering glutamine postoperatively to elective surgery patients can help speed recovery and shorten hospital stay, according to a study by Canadian researchers.

Elective surgeries represent controlled traumatic situations that cause muscles to break down protein to release glutamine, which fosters tissue repair and overall recovery. However, the breakdown of muscle also places the body in a state of oxidative stress. As a result, patients can lose as much as 40% of their glutamine levels following major surgery, according to Adebola O.E. Obayan, MD, PhD, a research affiliate with the department of surgery at the University of Saskatchewan, Saskatchewan.

Obayan and colleagues conducted a prospective study to evaluate the effect of glutamine supplementation following elective surgery. The researchers randomly assigned 69 patients to receive either 0.3 g/kg alanyl-glutamine in tube feedings within eight hours postop or to no supplementation. Indicators of oxidative stress were then measured over 72 hours follow-up.

Surgeons performed laparotomy procedures in 76% of cases and craniotomy procedures in 14.5%. Diagnoses included cancerous diseases in 55.7% of patients and noncancerous conditions in 44.3%. Of the 69 patients, 53.7% received glutamine supplementation and the remaining 46.3% served as a control group, according to the study, which Obayan presented at the 2005 Clinical Congress of the American College of Surgeons (ACS).

The researchers found that glutamine supplementation increased plasma glutamine and significantly increase bloodstream antioxidant levels (P=.05) throughout the 72-hour follow-up period. Patients who received glutamine supplementation also lost less lean body mass and had significantly lower oxidant levels at 24 hours follow-up (P=.036).

Additionally, glutamine-supplemented patients had significantly lower resource intensity-weighting scores and were discharged from the hospital an average of one day earlier (P=.008), according to the study.

“Glutamine is a precursor of glutamate and it enhances the synthesis of the antioxidant glutathione, the body’s principal antioxidant. In the past, if it was given as a nutritional supplement, it was administered with other nutrients. This study showed that glutamine affects hospital stay on its own,” Obayan said in an ACS press release announcing the study results.

The surgeons who participated in the study are now making glutamine supplementation a standard part of their perioperative surgical protocol for general surgery patients, as well as orthopedic surgery patients, in order to prevent oxidative stress and improve clinical outcomes. The surgeons also plan to administer glutamine before elective procedures, according to the press release.

“Within the first 24 hours after an operation, there is a great need for this substance to balance out the release of free radicals. Having glutamine in the circulation before a surgical procedure does patients more good than it does afterward,” Obayan said in the release.