The main objective of this study was to evaluate the 5-day kinetics of plasma paracetamol levels in postoperative major hepatic surgery (resection greater than or equal to three hepatic segments) compared with less extensive liver resection and hepatic re-intervention. The clearance of indocyanine green is a marker of hepatic perfusion but also of the proper hepatocyte functioning, if hemodynamic conditions are stable. Some patients may be operated on up to four or five times in the liver. Moreover, these patients probably present an increased risk of postoperative hepatocellular insufficiency due to a quantitative and qualitative decrease in their hepatic parenchyma. It is therefore interesting to evaluate the use of paracetamol in this situation.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
DIAGNOSTIC
Masking
NONE
Enrollment
90
Paracetamol 1000 mg will be administered 30 minutes before the end of the procedure and then every 6 hours systematically at the following times: 6h / 12h / 18h / 00h. The analgesic treatment after hepatectomy with paracetamol will be maintained for at least 5 days in all patients in parenteral form
Hôpital Huriez, CHRU
Lille, France
Dosing and kinetics of paracetamolemia
this determination of the plasma paracetamol dosage on D0 (H6: 6 hours after the end of the procedure) and D1 D2 D3 D4 D5 (samples taken at 6 am each day just before the injection of paracetamol whose administration hours will be 6h 12h 18h and midnight)
Time frame: during the 5 post-operative days
Dosage of urinary metabolites of paracetamol (paracetamol sulphate, paracetamol glucuronide)
Time frame: At Day 1, day 3, day 5 post operative
Dosage of N-acetyl-cysteinyl paracetamol ( NAPQI)
Time frame: At Day 1, day 3, day 5 post operative
Percentage of patients with paracetamolemia greater than 60 mg / mL
60mj/ml = paracetamol toxicity threshold according to Prescott diagram to 6 hours
Time frame: during the 5 post-operative days
Plasma Disappearance Rate of indocyanine green (TDP-ICG) by LiMon®
Time frame: At Day 1, day 3, day 5 post operative
Rate of postoperative hepatocellular insufficiency
The postoperative hepatocellular insufficiency according to the 50/50 criteria (TP \<50% and bilirubinemia\> 50 μmol / L on the 5th day) according to the type of hepatic resection (with or without clamping, continuous or discontinuous, duration intervention).
Time frame: at day 5
Occurrence of complications related to hepatic failure
the complications related to hepatic failure not falling within the "50/50" criteria: jaundice, hepatic encephalopathy, coagulation disorders, ascites, cytolysis, cholestasis. Other medical and surgical. Duration of hospitalization in perioperative intensive care and duration of total hospitalization. Mortality at 30 days.
Time frame: at day 5
Duration of hospitalization in perioperative intensive care
Time frame: at 30 days
Duration of total hospitalization.
Time frame: at 30 days
Mortality
Time frame: at 30 days
Composite characteristics of surgery.
Characteristics of surgery: duration of intervention, numbers, duration and types of vascular clamping, detailed description of the type of liver resection performed, quantification of bleeding.
Time frame: at 30 days
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